Systems and methods for assessing the potential for fraud in business transactions
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Abstract
Methods and systems are provided for assessing the potential for fraud of an insurance claim. In some embodiments, request data may be provided to a computer system. In some embodiments, at least one fraud potential indicator may be assessed to the request data from at least one comparison of at least one request data element to at least one fraud model. In some embodiments, a fraud potential indicator may be an estimate of the potential for fraud in an insurance claim. In some embodiments, at least one fraud potential indicator for request data may be assessed based on at least one comparison of at least one request data element to additional insurance data. Some embodiments may include assessing at least one fraud potential indicator for request data based on at least one fraud potential indicator.
209 Citations
237 Claims
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1-157. -157. (canceled)
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158. A method managing requests comprising:
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accessing a request processing system through a user system;
transmitting one or more requests to the request processing system, wherein a request comprises one or more request data elements;
assessing at least one fraud potential indicator for a request, wherein a fraud potential indicator is assigned based on at least two of;
a comparison of one or more request data elements to data in a database;
a comparison of one or more request data elements to one or more fraud models; and
an application of one or more business rules to one or more request data elements;
wherein a fraud potential indicator comprises an estimate of a probability of fraud in the request; and
automatically assigning the request if one or more fraud potential indicators is within a fraud range. - View Dependent Claims (159, 160, 161, 166, 183, 184, 185, 186, 187, 188, 189, 190, 191, 192, 193, 194, 195)
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162-165. -165. (canceled)
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167-182. -182. (canceled)
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196. (canceled)
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197. A carrier medium comprising program instructions, wherein the program instructions are executable to implement:
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accessing a request processing system through a user system;
transmitting one or more requests to the request processing system, wherein a request comprises one or more request data elements;
assessing at least one fraud potential indicator for a request, wherein a fraud potential indicator is assigned based on at least two of;
a comparison of one or more request data elements to data in a database;
a comparison of one or more request data elements to one or more fraud models; and
an application of one or more business rules to one or more request data elements;
wherein a fraud potential indicator comprises an estimate of a probability of fraud in the request; and
automatically assigning the request if one or more fraud potential indicators is within a fraud range.
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198-235. -235. (canceled)
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236. An insurance processing system comprising:
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a CPU;
a memory coupled to the CPU, wherein the memory comprises program instructions executable to implement;
accessing a request processing system through a user system;
transmitting one or more requests to the request processing system, wherein a request comprises one or more request data elements;
assessing at least one fraud potential indicator for a request, wherein a fraud potential indicator is assigned based on at least two of;
a comparison of one or more request data elements to data in a database;
a comparison of one or more request data elements to one or more fraud models; and
an application of one or more business rules to one or more request data elements;
wherein a fraud potential indicator comprises an estimate of a probability of fraud in the request; and
automatically assigning the request if one or more fraud potential indicators is within a fraud range.
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237-274. -274. (canceled)
Specification