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Data misrepresentation detection for insurance underwriting fraud prevention
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2022 | Decision Support Systems | Citations: 0
Authors: Vandervorst, Félix; Verbeke, Wouter; Verdonck, Tim

Abstract: Premium fraud concerns data misrepresentation committed by an insurance customer ... Expand

Abstract: Premium fraud concerns data misrepresentation committed by an insurance customer with the intent to benefit from an unduly low premium at the underwriting of a policy. In this paper, we propose a novel approach for evaluating the risk of underwriting premium fraud at the time of application in the presence of potentially misrepresented self-reported information. The aim of the approach is to support insurance companies in iden tifying fraudulent applications and their decisions to underwrite insurance contract propositions. Likewise, it can be use to make straight-through processing (i.e. automated) underwriting systems more fraudproof, by e.g., triggering a validation on applications prone to misrepresentations. Our approach is based on conditional density estimates for a set of validated contracts. The proposed approach does not require historical fraud labels and can adapt to changes in pricing policy. Moreover, the approach can be used to detect outliers in addition to predicting underwriting fraud and is extended to multivariate self-reported data. We further demonstrate a link between Shapley values in common conditional expectation problems and conditional density estimations to make our approach explainable. We report a case study involving motor insurance underwriting, in which a driver’s identity and driving record can be misrepresented to benefit from an unduly low premium; the results indicate the effectiveness of the proposed approach for detecting and preventing underwriting fraud. Collapse

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Topics: price management shapley additive explanation fraud detection information graphic decision support system

Methods: random forest classification computational algorithm self reported survey case study decision tree classification
An Instrument for Measuring SOA Maturity

2011 | International Conference on Information Systems | Citations: 4
Authors: Joachim, Nils; Beimborn, Daniel; Weitzel, Tim

Abstract: Existing empirical research on the business value of Service-Oriented Architectu ... Expand

Abstract: Existing empirical research on the business value of Service-Oriented Architectures (SOA) has only measured the extent of SOA adoption – but not maturity – to determine whether typical goals, like increased business agility or IT cost reduction, could be achieved. However, a widely implemented SOA might be less mature than an SOA adopted only in particular areas of the organization, which in turn can lead to mismeasurement and misinterpretation. On the other side, the few existing SOA maturity frameworks that have been specified by previous researchers lack valid operationalizations to make them applicable to empirical research. Ready to use items and scales for evaluating the particular maturity level of an organization are missing. Collapse

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Topics: organizational value business process management IT investment systems development IS management

Methods: maturity model survey design science survey design field study

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Data misrepresentation detection for insurance underwriting fraud prevention

An Instrument for Measuring SOA Maturity