Most fraud-fighting tools fall into one of three categories:Rules-based systems, also known as expert systems, "score" the probability that a claim has some element of fraud. Data elements from a claim-names, addresses, descriptions of damages or injuries-are run against a pre-defined set of fraud indicators. The downside of these systems is they generate many false-positive results.
Predictive modeling also scores claims on the probability of fraud, but instead of rules, it uses a carrier's own historical claims and fraud investigation data. Complex algorithms can be developed for each line of business. The models "predict" the probability of fraud based on past claims that were investigated for fraud.
Register or login for access to this item and much more
All Digital Insurance content is archived after seven days.
Community members receive:
- All recent and archived articles
- Conference offers and updates
- A full menu of enewsletter options
- Web seminars, white papers, ebooks
Already have an account? Log In
Don't have an account? Register for Free Unlimited Access