Systems and methods for assessing the potential for fraud in business transactions
First Claim
1. A method of managing insurance claim requests comprising:
- accessing, by a user system, an insurance request processing computer system;
transmitting one or more insurance claim requests relating to an accident to the insurance request processing computer system, wherein at least one of the insurance claim requests comprises one or more request data elements;
assessing, by the insurance request processing computer system, at least one fraud potential indicator for an insurance claim request relating to the accident, wherein the at least one fraud potential indicator comprises a numerical estimate of a probability of fraud in the insurance claim request, wherein the assessing of the at least one fraud potential indicator comprises;
comparing, by the insurance request processing computer system, at least one of the request data elements to one or more fraud models comprising at least one historical fraud pattern derived from insurance claims that have been proven fraudulent, wherein comparison of the at least one of the request data elements to one or more fraud models comprises searching for request patterns in the one or more request data elements that are similar to the at least one historical fraud pattern; and
applying, by the insurance request processing computer system, one or more business rules to at least one of the request data elements, the application of the one or more business rules comprising;
computing one or more numerical values for the at least one fraud potential indicator using one or more formulas, wherein computing at least one of the numerical values for the at least one fraud potential indicator comprises;
multiplying a loss type multiplier by at least one other numerical value to produce the numerical value for the at least one fraud potential indicator, wherein the value of the loss type multiplier varies depending on the type of accident; and
automatically assigning the insurance claim request if one or more fraud potential indicators is within a fraud range.
1 Assignment
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Accused Products
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.
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Citations
24 Claims
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1. A method of managing insurance claim requests comprising:
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accessing, by a user system, an insurance request processing computer system; transmitting one or more insurance claim requests relating to an accident to the insurance request processing computer system, wherein at least one of the insurance claim requests comprises one or more request data elements; assessing, by the insurance request processing computer system, at least one fraud potential indicator for an insurance claim request relating to the accident, wherein the at least one fraud potential indicator comprises a numerical estimate of a probability of fraud in the insurance claim request, wherein the assessing of the at least one fraud potential indicator comprises; comparing, by the insurance request processing computer system, at least one of the request data elements to one or more fraud models comprising at least one historical fraud pattern derived from insurance claims that have been proven fraudulent, wherein comparison of the at least one of the request data elements to one or more fraud models comprises searching for request patterns in the one or more request data elements that are similar to the at least one historical fraud pattern; and applying, by the insurance request processing computer system, one or more business rules to at least one of the request data elements, the application of the one or more business rules comprising; computing one or more numerical values for the at least one fraud potential indicator using one or more formulas, wherein computing at least one of the numerical values for the at least one fraud potential indicator comprises; multiplying a loss type multiplier by at least one other numerical value to produce the numerical value for the at least one fraud potential indicator, wherein the value of the loss type multiplier varies depending on the type of accident; and automatically assigning the insurance claim request if one or more fraud potential indicators is within a fraud range. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22)
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23. A computer readable non-transitory storage medium comprising program instructions stored thereon, wherein the program instructions are executable to implement:
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accessing, by a user system, an insurance request processing computer system; transmitting one or more insurance claim requests relating to an accident to the insurance request processing computer system, wherein at least one of the insurance claim requests comprises one or more request data elements; assessing, by the insurance request processing computer system, at least one fraud potential indicator for an insurance claim request relating to the accident, wherein the at least one fraud potential indicator comprises a numerical estimate of a probability of fraud in the insurance claim request, wherein the assessing of the at least one fraud potential indicator comprises; comparing, by the insurance request processing computer system, at least one of the request data elements to one or more fraud models comprising at least one historical fraud pattern derived from insurance claims that have been proven fraudulent, wherein comparison of the at least one of the request data elements to one or more fraud models comprises searching for request patterns in the one or more request data elements that are similar to the at least one historical fraud pattern; and an application of applying, by the insurance request processing computer system, one or more business rules to at least one of the request data elements, the application of the one or more business rules comprising;
computing one or more numerical values for the at least one fraud potential indicator using one or more formulas, wherein computing at least one of the numerical values for the at least one fraud potential indicator comprises;multiplying a loss type multiplier by at least one other numerical value to produce the numerical value for the at least one fraud potential indicator, wherein the value of the loss type multiplier varies depending on the type of accident; and automatically assigning the insurance claim request if one or more fraud potential indicators is within a fraud range.
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24. 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 an insurance request processing computer system; transmitting one or more insurance claim requests relating to an accident to the insurance request processing computer system, wherein at least one of the insurance claim requests comprises one or more request data elements; assessing at least one fraud potential indicator for an insurance claim request relating to the accident, wherein the at least one fraud potential indicator comprises a numerical estimate of a probability of fraud in the insurance claim request, wherein the assessing of the at least one fraud potential indicator comprises; comparing at least one of the request data elements to one or more fraud models comprising at least one historical fraud pattern derived from insurance claims that have been proven fraudulent, wherein comparison of the at least one of the request data elements to one or more fraud models comprises searching for request patterns in the one or more request data elements that are similar to the at least one historical fraud pattern; and applying one or more business rules to at least one request data elements, the application of the one or more business rules comprising; computing one or more numerical values for the at least one fraud potential indicator using one or more formulas, wherein computing at least one of the numerical values for the at least one fraud potential indicator comprises;
multiplying a loss type multiplier by at least one other numerical value to produce the numerical value for the at least one fraud potential indicator, wherein the value of the loss type multiplier varies depending on the type of accident; andautomatically assigning the insurance claim request if one or more fraud potential indicators is within a fraud range.
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Specification