Results 91 to 100 of about 23,659 (287)

FACTORS RELATED TO PENDING CLAIM IN INDONESIAN NATIONAL HEALTH INSURANCE (JKN): A SYSTEMATIC REVIEW

, 2019
Background: The number of Indonesian National Health Insurance (JKN) member is increasing every year. It is bringing impact to the hospital and Social Security Organizing Agency (BPJS) of health.
Soewondo, Prastuti, Semarajana, I Nyoman Gede   +1 more
core  

ANK1 and EPB41 Variants and the Risk of Steroid‐Induced Osteonecrosis

Arthritis &Rheumatology, EarlyView.
Objective Steroid‐induced osteonecrosis of the femoral head (SONFH) is a refractory skeletal disorder influenced by genetic and environmental factors. However, conclusive pathogenic genetic evidence remains elusive due to the limited exploration of rare damaging variants. In this study, we aimed to identify rare variants associated with SONFH.
Shengbao Chen, Xianmin Zhu, Zhongzhong Chen, Wei Chen, Hussam Alkaissi, Zeng Zhang, Yun Gao, Junhui Yin, Xiangtian Yu, Qiong Fu, Youshui Gao, Zhenzhong Zhu, Qianying Cai, Pengwei Zhang, Weibin Chen, Xin Zhao, Xiaojin Wu, Karel Pacak, Dongxu Jin, Chunde Bao, Zhengping Zhuang, Changqing Zhang   +21 more
wiley   +1 more source

A Kenyan insurance fraud scoring system: life insurance

, 2015
The aim of this study was to determine claim characteristics that are correlated with the occurrence of insurance fraud and to, additionally, developing a fraud scoring model.
Ong' ang'o, Josephat Auma
core  

Inferring Rheumatoid Arthritis Disease Activity Status From the Electronic Health Records Across Health Systems

Arthritis &Rheumatology, EarlyView.
Objective Disease activity plays a central role in rheumatoid arthritis (RA) clinical studies. The inconsistent availability of data on disease activity in real‐world electronic health records (EHRs) data has limited the ability to generate real‐world evidence (RWE).
David Cheng, Xuan Wang, Gregory C. McDermott, Jennifer S. Hanberg, Zoe Love, Katherine Zhong, Mary Jeffway, Jue Hou, Vidul Panickan, Rahul Sangar, Ying Qi, Connor Melley, Lauren Costa, Dakota Feil, Rachael Matty, Dana Weisenfeld, Abisayo Animashaun, Aimee Schreiner, Sara Morini, Lauren Rusnak, Andrew Cagan, Misti Paudel, J. Michael Gaziano, Brian Sauer, Michael Weinblatt, Joshua Baker, Bryant England, Yuk‐Lam Ho, Kelly Cho, Paul Monach, Grant W. Cannon, Nancy Shadick, Ted R. Mikuls, Tianxi Cai, Katherine P. Liao   +34 more
wiley   +1 more source

Optimal auditing with scoring: theory and application to insurance fraud

This article makes a bridge between the theory of optimal auditing and the scoring methodology in an asymmetric information setting. Our application is meant for insurance claims fraud, but it can be applied to many other activities that use the scoring ...
Giuliano, Florence, Dionne, Georges, Picard, Pierre   +2 more
core  

An IBNR–RBNS insurance risk model with marked Poisson arrivals

, 2018
Inspired by the claim reserving problem in non-life insurance, this paper proposes to study the insurer’s surplus process under a micro-level framework, with particular focus on modeling the Incurred But Not Reported (IBNR) and the Reported But Not ...
Soohan Ahn, Eric C.K. Cheung, Cheung, E ; https://orcid.org/, Andrei L. Badescu, Badescu, AL, Jeong-Rae Kim, Kim, J-R, Ahn, S   +7 more
core   +1 more source

A Pragmatic Trial of a Shared Decision‐Making Intervention to Improve Medication Adherence and Outcomes in Systemic Lupus Erythematosus: The HCQ‐SAFE Study

Arthritis &Rheumatology, EarlyView.
Objective Hydroxychloroquine (HCQ) nonadherence in systemic lupus erythematosus (SLE) stemming from decision complexities can be improved with shared decision‐making (SDM) tools clarifying benefits and harms. This study aimed to develop and evaluate HCQ‐SAFE, a pictogram‐based SDM tool during SLE visits.
Caroline Packee, Jay J. Patel, Jessica Kent, Betty Chewning, Sancia Ferguson, Patricia Tellez‐Giron, David Gazeley, Christie M. Bartels, Shivani Garg   +8 more
wiley   +1 more source

YUNet_LLMClaimReport: An Enhanced Automobile Insurance Fraud Detection and Automated Claim Report Generation Using Large Language Models

IEEE Access
The detection of fraud in automobile insurance and processing of automobile claims are still a challenge since manual inspections are carried out and automated systems are fragmented. The state-of-the-art approaches (convolutional neural networks, statistical models, etc.) tend to focus on separate tasks (damage detection, fraud classification, etc ...
P. Anand Kumar, Sountharrajan Sehar
openaire   +2 more sources

Optimal Claim Reporting Strategies and Bonus Hunger in Automobile Insurance

This thesis investigates optimal claim reporting strategies in the context of automobile insurance, focusing on the phenomenon known as bonus hunger. Bonus-malus systems adjust insurance premiums based on claim history, rewarding claim-free policyholders
Ambartsumian, Ekaterina
core  

A machine learning approach for individual claims reserving in insurance

, 2019
International audienceAbstract Accurate loss reserves are an important item in the financial statement of an insurance company and are mostly evaluated by macrolevel models with aggregate data in run‐off triangles.
Christian Y. Robert, Robert, Christian Y., Baudry, Maximilien, Maximilien Baudry   +3 more
core   +1 more source