insurance industry experts believe that fraud is a destructive disaster in the insurance industry. over the years, many methods have been used in the literature for fraud detection, one of which is expert systems. fraud detection expert systems are based on the knowledge of experts in the field of insurance identify fraud. judgment of experts is mostly based on evidence, documents, qualitative ...

Collecting insurance fraud samples is costly and if performed manually is very time consuming. This issue suggests usage of unsupervised models. One of the accurate methods in this regards is Spectral Ranking of Anomalies (SRA) that is shown to work better than other methods for auto insurance fraud detection specifically. However, this approach is not scalable to large samples and is not appro...

Fraud is a significant problem in many industries, such as banking, insurance, telecommunication, and public service. Detecting and preventing fraud is difficult, because fraudsters develop new schemes all the time, and the schemes grow more and more sophisticated to elude easy detection. Many organizations have implemented fraud detection and prevention systems based on SAS data mining to help...

Adaptive Benford’s Law [1] is a digital analysis technique that specifies the probabilistic distribution of digits for many commonly occurring phenomena, even for incomplete data records. We combine this digital analysis technique with a reinforcement learning technique to create a new fraud discovery approach. When applied to records of naturally occurring phenomena, our adaptive fraud detecti...

This paper presents a review of the literature on the application of data mining techniques for the detection of insurance fraud. Academic literature were analyzed and classified into three types of insurance fraud (automobile insurance, crop insurance and healthcare insurance) and six classes of data mining techniques (classification, regression, clustering, prediction, outlier detection, and ...

Insurance companies, third party insurance administrators, state insurance funds, state regulatory agencies, insurance industry consultants, and application service providers (ASP) use SAS software in a variety of predictive modeling situations. SAS Enterprise Miner provides tools for modeling continuous responses, such as monetary losses and time off work, and discrete responses, such as fraud...

62 Abstract— With an increase in financial accounting fraud in the current economic scenario experienced, financial accounting fraud detection has become an emerging topics of great importance for academics, research and industries. Financial fraud is a deliberate act that is contrary to law, rule or policy with intent to obtain unauthorized financial benefit and intentional misstatements or om...