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The article proposes an expert system for detection, and subsequent investigation, of groups of collaborating automobile insurance fraudsters. The system is described and examined in great detail, several technical difficulties in detecting…

人工智能 · 计算机科学 2011-04-21 Lovro Šubelj , Štefan Furlan , Marko Bajec

As machine learning (ML) systems become increasingly widespread, it is necessary to audit these systems for biases prior to their deployment. Recent research has developed algorithms for effectively identifying intersectional bias in the…

Fraud acts as a major deterrent to a companys growth if uncontrolled. It challenges the fundamental value of Trust in the Insurance business. COVID-19 brought additional challenges of increased potential fraud to health insurance business.…

Accounting fraud is a global concern representing a significant threat to the financial system stability due to the resulting diminishing of the market confidence and trust of regulatory authorities. Several tricks can be used to commit…

机器学习 · 统计学 2018-05-09 Maria Jofre , Richard Gerlach

Medical insurance claims are of organized crimes related to patients, physicians, diagnostic centers, and insurance providers, forming a chain reaction that must be monitored constantly. These kinds of frauds affect the financial growth of…

机器学习 · 计算机科学 2023-08-15 Jayanthi Vajiram , Negha Senthil , Nean Adhith. P

Occupational fraud affects many companies worldwide causing them economic loss and liability issues towards their customers and other involved entities. Detecting internal fraud in a company requires significant effort and, unfortunately…

计算机与社会 · 计算机科学 2013-04-25 Evmorfia N. Argyriou , Aikaterini A. Sotiraki , Antonios Symvonis

We present a prototype system developed in cooperation with a business organization that combines information visualization and pattern-matching techniques to detect fraudulent activity by employees. The system is built upon common fraud…

其他计算机科学 · 计算机科学 2013-12-02 Evmorfia N. Argyriou , Antonios Symvonis , Vassilis Vassiliou

Frauds severely hurt many kinds of Internet businesses. Group-based fraud detection is a popular methodology to catch fraudsters who unavoidably exhibit synchronized behaviors. We combine both graph-based features (e.g. cluster density) and…

密码学与安全 · 计算机科学 2018-06-26 Yikun Ban , Xin Liu , Tianyi Zhang , Ling Huang , Yitao Duan , Xue Liu , Wei Xu

Fraud causes substantial costs and losses for companies and clients in the finance and insurance industries. Examples are fraudulent credit card transactions or fraudulent claims. It has been estimated that roughly $10$ percent of the…

机器学习 · 计算机科学 2019-10-09 I. Fursov , A. Zaytsev , R. Khasyanov , M. Spindler , E. Burnaev

In the insurance industry detecting fraudulent claims is a critical task with a significant financial impact. A common strategy to identify fraudulent claims is looking for inconsistencies in the supporting evidence. However, this is a…

机器学习 · 计算机科学 2023-01-19 Azin Asgarian , Rohit Saha , Daniel Jakubovitz , Julia Peyre

Few-shot-based facial recognition systems have gained increasing attention due to their scalability and ability to work with a few face images during the model deployment phase. However, the power of facial recognition systems enables…

密码学与安全 · 计算机科学 2023-04-07 Min Chen , Zhikun Zhang , Tianhao Wang , Michael Backes , Yang Zhang

The Automobile Insurance Fraud is one of the main challenges for insurance companies. This form of fraud is performed either opportunistic or professional occurring through group cooperation that leads to greater financial losses, while…

社会与信息网络 · 计算机科学 2018-06-20 Arezo Bodaghi , Babak Teimourpour

Financial fraud detection in real-world scenarios presents significant challenges due to the subtlety and dispersion of evidence across complex, multi-year financial disclosures. In this work, we introduce a novel multi-agent reasoning…

人工智能 · 计算机科学 2025-10-02 Songran Bai , Bingzhe Wu , Yiwei Zhang , Chengke Wu , Xiaolong Zheng , Yaze Yuan , Ke Wu , Jianqiang Li

Generative AI is supercharging insurance fraud by making it easier to falsify accident evidence at scale and in rapid time. Insurance fraud is a pervasive and costly problem, amounting to tens of billions of dollars in losses each year. In…

人工智能 · 计算机科学 2025-10-24 Amir Hever , Itai Orr

Given a set of financial transactions (who buys from whom, when, and for how much), as well as prior information from buyers and sellers, how can we find fraudulent transactions? If we have labels for some transactions for known types of…

机器学习 · 计算机科学 2025-10-07 Robson L. F. Cordeiro , Meng-Chieh Lee , Christos Faloutsos

Financial fraud is an issue with far reaching consequences in the finance industry, government, corporate sectors, and for ordinary consumers. Increasing dependence on new technologies such as cloud and mobile computing in recent years has…

密码学与安全 · 计算机科学 2015-10-27 J. West , Maumita Bhattacharya , R. Islam

As online fraudsters invest more resources, including purchasing large pools of fake user accounts and dedicated IPs, fraudulent attacks become less obvious and their detection becomes increasingly challenging. Existing approaches such as…

社会与信息网络 · 计算机科学 2017-05-26 Shenghua Liu , Bryan Hooi , Christos Faloutsos

Traditionally, the detection of fraudulent insurance claims relies on business rules and expert judgement which makes it a time-consuming and expensive process (\'Oskarsd\'ottir et al., 2022). Consequently, researchers have been examining…

机器学习 · 计算机科学 2024-10-08 Bavo D. C. Campo , Katrien Antonio

Fraudulent claim detection is one of the greatest challenges the insurance industry faces. Alibaba's return-freight insurance, providing return-shipping postage compensations over product return on the e-commerce platform, receives…

密码学与安全 · 计算机科学 2020-03-02 Chen Liang , Ziqi Liu , Bin Liu , Jun Zhou , Xiaolong Li , Shuang Yang , Yuan Qi

Healthcare insurance provides financial support to access medical services for patients while ensuring timely and guaranteed payment for providers. Insurance fraud poses a significant challenge to insurance companies and policyholders,…

密码学与安全 · 计算机科学 2024-07-26 Md Al Amin , Rushabh Shah , Hemanth Tummala , Indrajit Ray
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