Insurance claims management is the process of managing a claim from reception to settlement. The insurance claim process is particularly suited to machine learning solutions as much can be done to cut time and costs, leading to speedier resolution of claims to the satisfaction of both insurer and insured.
Insurance fraud can be committed by either the buyer or the seller of an insurance policy.
The seller may offer policies from non-existent companies, fail to submit premiums, and churn policies to create more commissions. The buyer exaggerate claims, falsify medical history, post-date policies, sell their policy to for cash when they are diagnosed with a terminal disease, or fake their death or kidnapping. We will focus on the buyer insurance fraud in this post.
Historically, insurers have relied on linear regression of a small number of risk factors, largely reported by the policy-holder on a trust basis, to determine an insurance premium. However, a good prediction model of individual future insurance costs is becoming a business essential as competition in the insurance industry and low customer switching costs have become key drivers for insurers to build a pricing structure which covers their incurred costs.