Healthcare insurance claim fraud detection using datasets derived from multiple insurersVarious techniques are described that enable a smaller insurer (or an insurer with a less developed dataset) to be able to characterize whether certain healthcare insurance claim elements are potentially fraudulent or ...
Identifying specific claim line details that underpin the fraud is also challenging, given that such billing discrepancies often pertain to the overall behavior of the provider. Therefore, in our study we employ the unsupervised methods in combination with rule-based approach for detection to mitigate...
The Future of Insurance Fraud Detection is Predictive Analytics DAP GUIDE What Is a Digital Adoption Platform? Read Now → Subscribe to the Digital Adoption Insider Newsletter Join our monthly newsletter for best practices, insights, and trends on user adoption, technology ROI, digital workplace, an...
The final insurance price also implies the operating costs and the expected profit of the insurer. An additional margin might be also considered. However, as no reliable data on the history of cyber insurance is available so far, the loss/claim requirement/demand must be computed without own ex...
The product helps insurance companies with risk profiling, premium optimization, and even fraud detection. On top of that, the MyDrive app encourages safe driving by providing drivers with tips and feedback. Image analysis in claim assessment Nearly all types of insurance...
Capitalizing on these technologies, we launched the "Ping An Motor Insurance Trust Claim" service for auto owners with safe driving behaviors. Through this pioneering service, we shortened the annual average turnaround time of a single claim to only 3 minutes, with no back-end manual operation ...
Predictive Modeling for Property-Casualty Insurance.ppt,Predictive Modeling for Property-Casualty Insurance James Guszcza, FCAS, MAAA Peter Wu, FCAS, MAAA SoCal Actuarial Club LAX September 22, 2004 Predictive Modeling: 3 Levels of Discussion Strategy Pr
healthcare big data can reduce medical expenses compensation pay-outs by promoting the establishment of a management medical system. Finally, the use of healthcare big data improves operational efficiency by increasing payment speeds, identifying fraud and increasing claim verification processes through aut...
The remainder of this paper is structured as follows. The next section provides a summary of the most relevant literature. Then, we introduce the dataset and methodology. The fourth section presents the results of our analysis. The final section concludes with a discussion of the findings and li...
Healthcare insurance claim fraud detection using datasets derived from multiple insurersVarious techniques are described that enable a smaller insurer (or an insurer with a less developed dataset) to be able to characterize whether certain healthcare insurance claim elements are potentially fraudulent or ...