Visual Analysis For Insurance Fraud Detection and Investigation - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

Visual Analysis For Insurance Fraud Detection and Investigation

Description:

... including Merry Hider, I.M. Pompous, and Daffy Von Flake, are staging accidents. Daffy Von Flake is steering the claimants to Dr. Frank N. Stein, who is ... – PowerPoint PPT presentation

Number of Views:1551
Avg rating:3.0/5.0
Date added: 24 July 2020
Slides: 33
Provided by: valerie116
Learn more at: http://www.casact.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Visual Analysis For Insurance Fraud Detection and Investigation


1
Visual Analysis For Insurance Fraud Detection
and Investigation
  • Valerie A. Zicko CCA, CFE

2
Agenda
  • Finding Good Claims Data
  • The Analytical Process
  • Visual Analysis
  • Visual Analysis And Visual Mining Software
  • Examples of Visual Analysis
  • Pros and Cons of the The Software

3
Keys to Successful Analysis
4
Finding Good Claims Data
  • Finding Related Claims is the Heart of Case
    Investigation and Fraud Detection
  • Claims Databases are the Most Effective Tool for
    Finding Claims

5
Finding Good Claims Data
  • Their Effectiveness is Directly Related to the
    Quality and Completeness of the Database
  • Multiple identifiers for a person Name, SSN,
    DOB, Address
  • Properly formatted address
  • SSN preferably a verified SSN
  • Service providers

6
Analysis
  • Is the process of adding meaning to collected
    information
  • Requires going beyond the facts

7
Connect all the dots by using only three lines
8
Connect all the dots by using only three lines
9
(No Transcript)
10
The Process
11
As a Result of the Analytical Process We
  • Identify what is known
  • Develop a hypothesis
  • Formulate a collection plan for the missing
    information
  • Develop leads for further investigation or
    research

12
  • The Hypothesis or Theory includes
  • Key Players WHO?
  • Criminal Activities WHAT?
  • Method of Operation HOW?
  • Geographical Scope WHERE?

13
SAMPLE HYPOTHESIS A group of claimants from
Watery Mills, including Merry Hider, I.M.
Pompous, and Daffy Von Flake, are staging
accidents. Daffy Von Flake is steering the
claimants to Dr. Frank N. Stein, who is providing
treatment and medical bills to support PIP/BI
claims for non-existent injuries. Confidence
Level Somewhat confident
14
The Product

15
Visual Analysis
  • Examine the data in terms of entities (fields)
    and relationships to discover or verify patterns,
    relationships and anomalies.
  • Visual cues are used to graphically depict the
    relationships an entities.
  • Operates at the detail/transaction level

16
An Everyday Visual Chart
17
Visual Analysis
  • Proactive
  • Seeks Out Patterns From Unrelated Data
  • General to Specific
  • Reactive
  • Seeks Additional Patterns in Related Data
  • Specific to General

18
Visual Analysis - Proactive
  • Large Segments of Analyzed to Discover Patterns
  • Claims for a Time Period
  • Claims for Geographic Area
  • Specific Claim Types
  • Subjects for Further Analysis May Emerge

19
Visual Analysis - Reactive
  • Specific Entities Are Targeted for a Drill Down
    Analysis.
  • From a Pattern Analysis
  • From a Suspicious Claim
  • Related Records Are Fed to the Analyzer

20
Visual Analysis Software
  • ALTA Analytics - NETMAP
  • Harlequin - WATSON
  • I2 - ANALYSTS NOTEBOOK
  • Winshapes - CASELINK

21
ALTA Analytics - NETMAP
  • NETMAP for Claims
  • Works with your corporate database
  • NICB, AISG interface
  • Works on normal Ins. Link types
  • www.altaanlytics.com
  • Big Bucks -6 figures

22
Harlequin - WATSON
  • Database Chart Generator
  • Import your data
  • Pre-defined links
  • PC based
  • www.harlequin.com
  • Suite of programs
  • 1,000 to 15,000 per User

23
I2 ANALYSTS NOTEBOOK
  • Chart Generator
  • Reads your database for charts
  • User Specified links
  • Suite of programs
  • www.I2.co.uk
  • PC based
  • 5,000 to 8,000 per User

24
Winshapes - CASELINK
  • PC Based
  • Database Chart Generator
  • Predefined Links
  • Designed for SIU
  • www.winshapes.com
  • 795 per user

25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
Visual Analysis Benefits
  • Links types are pre-defined by software
  • Enter data once - generate multiple charts
  • Auto update as new info added
  • Source data linked to chart
  • Can process large amounts of data
  • Data mining is intuitive

30
Visual Analysis Disadvantages
  • Can Be Limited to Pre-defined Links
  • Auto-generated Charts Can Look Like Dish of
    Spaghetti
  • Learning Time Effort
  • Program Makes Decisions. You Must Know How to Ask
    to Get the Desired Results.
  • Non-standard Situations Are Forced

31
Spaghetti
32
Summary
  • Analytical methods help see beyond the obvious
    facts
  • Computer tools can make analysis easier and
    faster
  • Visual analysis software permits larger amounts
    of data to be analyzed more quickly
  • Visual analysis displays information in a
    graphical manner which aids clarity.
  • Nothing replaces digging for the facts.
About PowerShow.com