INSURANCE CLAIM VALIDATION AND ANOMALY DETECTION BASED ON MODUS OPERANDI ANALYSIS

摘要

In one aspect, a method of computer-implemented insurance claim validation based on ARM (pattern analysis, recognition and matching) approach and anomaly detection based on modus operandi analysis including the step of obtaining a set of open claims data. One of more modus-operandi variables of the open claims set are determined. A step includes determining a match between the one or more modus operandi variables and a claim in the set of open claims. A step includes generating a list of suspected fraudulent claims that comprises each matched claim. A step includes implementing one or more machine learning algorithms to learn a fraud signature pattern in the list of suspected fraudulent claims. A step includes grouping the set of open claims data based on the fraud signature pattern as determined by the modus operandi variables.

主权项

1. A method of computer-implemented insurance claim validation based on ARM (pattern analysis, recognition and matching) approach and anomaly detection based on modus operandi analysis comprising:
obtaining a set of open claims data; determining one of more modus-operandi variables of the open claims set; determining a match between the one or more modus operandi variables and a claim in the set of open claims; generating a list of suspected fraudulent claims that comprises each matched claim; implementing one or more machine learning algorithms to learn a fraud signature pattern in the list of suspected fraudulent claims; and grouping the set of open claims data based on the fraud signature pattern as determined by the modus operandi variables.