Sequence embeddings help to identify fraudulent cases in healthcare insurance
This addresses fraud detection for insurance companies, offering an incremental improvement over existing machine learning methods.
The paper tackled fraud detection in healthcare insurance claims by proposing deep learning architectures for text embeddings, which outperformed other state-of-the-art methods in identifying fraudulent cases.
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 insurance industry's incurred losses and loss adjustment expenses each year stem from fraudulent claims. The rise and proliferation of digitization in finance and insurance have lead to big data sets, consisting in particular of text data, which can be used for fraud detection. In this paper, we propose architectures for text embeddings via deep learning, which help to improve the detection of fraudulent claims compared to other machine learning methods. We illustrate our methods using a data set from a large international health insurance company. The empirical results show that our approach outperforms other state-of-the-art methods and can help make the claims management process more efficient. As (unstructured) text data become increasingly available to economists and econometricians, our proposed methods will be valuable for many similar applications, particularly when variables have a large number of categories as is typical for example of the International Classification of Disease (ICD) codes in health economics and health services.