A Model for the Detection of Insurance Fraud
Bibliographic record
Abstract
The aim of this article is to develop a model to aid insurance companies in their decision-making and to ensure that they are better equipped to fight fraud. This tool is based on the systematic use of fraud indicators. We first propose a procedure to isolate the indicators which are most significant in predicting the probability that a claim may be fraudulent. We applied the procedure to data collected in the Dionne Belhadji study (1996). The model allowed us to observe that 23 of the 54 indicators used were significant in predicting the probability of fraud. Our study also discusses the model's accuracy and detection capability. The detection rates obtained by the adjusters who participated in the study constitute the reference point of this discussion. As shown in the Caron-Dionne (1998), there is the possibility that these rates underestimate the true level of fraud.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.031 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.006 | 0.007 |
| Open science | 0.005 | 0.002 |
| Research integrity | 0.007 | 0.004 |
| Insufficient payload (model declined to judge) | 0.017 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".