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INSURANCE CLAIM VALIDATION AND ANOMALY DETECTION BASED ON MODUS OPERANDI ANALYSIS
INSURANCE CLAIM VALIDATION AND ANOMALY DETECTION BASED ON MODUS OPERANDI ANALYSIS
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机译：基于模态操作分析的保险索赔确认和异常检测
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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.
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