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Fraud detection methods and systems

  • US 20140058763A1
  • Filed: 07/24/2013
  • Published: 02/27/2014
  • Est. Priority Date: 07/24/2012
  • Status: Abandoned Application
First Claim
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1. A fraud detection method, comprising:

  • obtaining data relating to a sample set of claims or transactions made to one of an insurer, guarantor, financial institution, and payor;

    obtaining external data relating to at least one of the claims, submissions, claimants, incidents and transactions giving rise to the claims or transactions in the set;

    using at least in part at least one data processing device, identifying from the data and the external data a set of variables usable to discover patterns in the data;

    using the at least one data processing device, discovering patterns in the set of variables that at least one of;

    indicate a normal profile of said claims or transactions, indicate an anomalous profile of said claims or transactions, and indicate a high propensity of fraud in said claims or transactions;

    assigning a new claim, not in the sample set, to at least one of the profiles; and

    outputting the identified potentially fraudulent new claims to a user as a basis for an investigative course of action.

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