Results 11 to 20 of about 161,189 (267)

Artificial intelligence applications in health insurances: a scoping review [PDF]

Cost Effectiveness and Resource Allocation
Introduction The rapid evolution of technology has reshaped the insurance industry, with artificial intelligence (AI) taking center stage as a key driver of innovation.
Maryam Ramezani-a, Ahad Bakhtiari, Mohammadreza Mobinizadeh, Rajabali Daroudi, Hamid R. Rabiee, Alireza Olyaeemanesh, Ali Akbar Fazaeli, Hakimeh Mostafavi, Maryam Ramezani-b, Saharnaz Sazgarnejad, Sanaz Bordbar, Amirhossein Takian   +11 more
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Using large language models for enhanced fraud analysis and detection in blockchain based health insurance claims [PDF]

Scientific Reports
Traditional health insurance claim processing systems are plagued by inefficiencies and vulnerabilities, often resulting in significant financial losses due to fraudulent activities.
Ruba Islayem, Senay Gebreab, Walaa AlKhader, Ahmad Musamih, Khaled Salah, Raja Jayaraman, Muhammad Khurram Khan   +6 more
doaj   +2 more sources

Holistic approach to fraud management in health insurance

Journal of Information and Organizational Sciences, 2008
Fraud present an immense problem for health insurance companies and the only way to fight fraud is by using specialized fraud management systems.
Štefan Furlan, Marko Bajec
doaj   +2 more sources

Explainable unsupervised anomaly detection for healthcare insurance data [PDF]

BMC Medical Informatics and Decision Making
Background Waste and fraud are important problems for health insurers to deal with. With the advent of big data, these insurers are looking more and more towards data mining and machine learning methods to help in detecting waste and fraud.
Hannes De Meulemeester, Frank De Smet, Johan van Dorst, Elise Derroitte, Bart De Moor   +4 more
doaj   +2 more sources

Urgensi Kriminalisasi Perbuatan Kecurangan (Fraud) dalam Pelaksanaan Program Jaminan Kesehatan di Indonesia

Interdisciplinary Journal on Law, Social Sciences and Humanities, 2023
In this study, the author discusses one of the problems regarding the Urgency of Criminalization of Fraud in the Implementation of the Health Insurance Program in Indonesia.
Solehuddin Solehuddin
doaj   +1 more source

Blockchain and AI-Empowered Healthcare Insurance Fraud Detection: an Analysis, Architecture, and Future Prospects

IEEE Access, 2022
Nowadays, health insurance has become an essential part of people’s lives as the number of health issues increases. Healthcare emergencies can be troublesome for people who can’t afford huge expenses.
Khyati Kapadiya, Usha Patel, Rajesh Gupta, Mohammad Dahman Alshehri, Sudeep Tanwar, Gulshan Sharma, Pitshou N. Bokoro   +6 more
doaj   +1 more source

Prediction of Insurance Fraud Detection using Machine Learning Algorithms

Mehran University Research Journal of Engineering and Technology, 2022
In current era, people are influenced with various types of insurance such as health insurance, automobile insurance, property insurance and travel insurance, due to the availability of extensive knowledge related to insurance.
Laiqa Rukhsar, Waqas Haider Bangyal, Kashif Nisar, Sana Nisar2b   +3 more
doaj   +1 more source

Sequence Embeddings Help Detect Insurance Fraud

IEEE Access, 2022
Roughly 10 percent of the insurance industry’s incurred losses are estimated to stem from fraudulent claims. One solution is to use tabular data to construct models that can distinguish between claims that are legitimate and those that are ...
Ivan Fursov, Elizaveta Kovtun, Rodrigo Rivera-Castro, Alexey Zaytsev, Rasul Khasyanov, Martin Spindler, Evgeny Burnaev   +6 more
doaj   +1 more source

Oversampling based on generative adversarial networks to overcome imbalance data in predicting fraud insurance claim

Kuwait Journal of Science, 2022
Fraud on health insurance has an impact not only on cost overruns, but also a decline in the quality of health services in long term. The use of machine learning to predict fraud on health insurance is increasingly popular.
Ranu Agastya Nugraha, Hilman Ferdinandus Pardede, Agus Subekti   +2 more
doaj   +1 more source

Explainable machine learning models for Medicare fraud detection

Journal of Big Data, 2023
As a means of building explainable machine learning models for Big Data, we apply a novel ensemble supervised feature selection technique. The technique is applied to publicly available insurance claims data from the United States public health insurance
John T. Hancock, Richard A. Bauder, Huanjing Wang, Taghi M. Khoshgoftaar   +3 more
doaj   +1 more source