Cookie Preference Centre

Your Privacy
Strictly Necessary Cookies
Performance Cookies
Functional Cookies
Targeting Cookies

Your Privacy

When you visit any web site, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences, your device or used to make the site work as you expect it to. The information does not usually identify you directly, but it can give you a more personalized web experience. You can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, you should know that blocking some types of cookies may impact your experience on the site and the services we are able to offer.

Strictly Necessary Cookies

These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms. You can set your browser to block or alert you about these cookies, but some parts of the site may not work then.

Cookies used

ContactCenterWorld.com

Performance Cookies

These cookies allow us to count visits and traffic sources, so we can measure and improve the performance of our site. They help us know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies, we will not know when you have visited our site.

Cookies used

Google Analytics

Functional Cookies

These cookies allow the provision of enhance functionality and personalization, such as videos and live chats. They may be set by us or by third party providers whose services we have added to our pages. If you do not allow these cookies, then some or all of these functionalities may not function properly.

Cookies used

Twitter

Facebook

LinkedIn

Targeting Cookies

These cookies are set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant ads on other sites. They work by uniquely identifying your browser and device. If you do not allow these cookies, you will not experience our targeted advertising across different websites.

Cookies used

LinkedIn

This site uses cookies and other tracking technologies to assist with navigation and your ability to provide feedback, analyse your use of our products and services, assist with our promotional and marketing efforts, and provide content from third parties

OK
BECOME
A MEMBER
TODAY TO:
CLICK HERE
[HIDE]

Here are some suggested Connections for you! - Log in to start networking.

Common Data Mining Techniques: Key to Detecting and Preventing Fraud - Sunil Kappal - ContactCenterWorld.com Blog

Common Data Mining Techniques: Key to Detecting and Preventing Fraud

In my past article "Detecting Healthcare Fraud Using Speech and Data Analytics" I have described at length about the two most robust and common techniques used to identify and predict fraud. However, this article focuses purely on the most common Data Mining method CRISP-DM "Cross Industry Standard for Data Mining Process" that can help organizations to mine the data using some common techniques to identify fraud.

Before we proceed we should understand what is Data Mining?

“The process of discovering meaningful new relationships, patterns and trends by sifting through data using pattern recognition technologies as well as statistical and mathematical techniques.” – Gartner Group


Sponsor message - content continues below this message

2022 '17th annual' Global Contact Center World Awards NOW OPEN

Enter your Center, Strategy, Technology Innovation, Teams and Individuals into the ONLY TRULY GLOBAL awards program - regarded by many as being like the Olympics for the Contact Center World! Join the best from over 80 nations and compete for the most prestigious awards out there!

FIND OUT MORE HERE


Content continues ….

Let’s look at some very common and basic fraud detecting techniques used based on the business motivation of either:

  1. Predicting or classifying a fraud
  2. Grouping or finding affinities/associations

 

  1. Techniques used to predict or classify a fraud
  • Regression algorithms: These algorithms predict a numeric outcome. Most commonly used algorithms are:
    1. Neural Networks
    2. Regression
    3. General Linear Modeling
  • Classification algorithms: These algorithms predict symbolic outcomes. Most commonly used algorithms are:
  1. CART
  2. Logistic Regression

 

  1. Techniques used to group and associate fraudulent transactions/events
    • Group and find association algorithms: K-means, Factor Analysis are amongst the most common and popular clustering and grouping algorithms used to detect fraud.
    • Association algorithms: Apriori algorithm is one of the most popular association algorithm used in the healthcare industry for frequent item set mining and association rule learning over the transaction database.

Use Case – 1: Regression

  • Predict the expected claim value, compare it with the acutal value of the submitted claim.
  • Cases falling outside the expected range should undergo rigorous scrutiny.

Use Case – 2: Decision Trees

  • Create characteristicts or provider profiles with fraudulent behaviors and indicators.
  • Extract cases meeting the historical characteristics of fraud

Use Case – 3: Clustering and Association

  • Group transaction by providers or trnasaction types
  • Find group events by using the association algorithms
  • Perform outlier identification analysis for further scrutiny

Benefits of Fraud Detecting using CRISP DM

  • Lends itself as a systematic tool and methodology set to detect and prevent fraud
  • Helps to maximize the investigative efforts in auditing fraudulent transactions
  • Results in higher recoupments
  • Continually updates the model to identify new emerging abuse patterns

 

 

 

 

 

Publish Date: February 17, 2016 2:08 PM

 1

About us - in 60 seconds!

Newsletter Registration

Please check to agree to be placed on the eNewsletter mailing list.

Latest Americas Newsletter
both ids empty
session userid =
session UserTempID =
session adminlevel =
session blnTempHelpChatShow =
CMS =
session cookie set = True
session page-view-total = 1
session page-view-total = 1
applicaiton blnAwardsClosed =
session blnCompletedAwardInterestPopup =
session blnCheckNewsletterInterestPopup =
session blnCompletedNewsletterInterestPopup =