Machine Learning Approaches to Safeguarding Health Insurance Against Fraudulent Claims
摘要
Several fraud-related threats present difficulties and risks within the insurance industry for both insurers and policyholders. To solve this problem adequately, this paper suggests the employment of data analytics in collaboration with machine learning to conduct insurance fraud detection. Expanding the problems of anomaly detection, predictive modeling, and network analysis, this paper is an attempt to enhance the current process toward fraud detection and to minimize the number of false positives observed. The methodology involves the use of several forms of data such as claim data, customer data, and previous cases of fraud for training and model testing. By elaborating detailed experimental and analytical work presented in this paper, it is possible to prove that the suggested technique can effectively detect several instances of fraudulent behavior and reduce overall financial losses. Moreover, the innovativeness of the research goes a step further by highlighting the implementation hurdles and potential ethical dilemmas that can be encountered while opting for ML-based fraud detection solutions in the insurance market. In general, this paper supports the further development of the approach to tackling fraud issues in the insurance industry, due to the incorporation of new data analysis techniques.