Enhancing Insurance Fraud Detection through Graph-Based Link Analysis

  The Challenge Technology is increasingly used as both a force for good and as a means to exploit vulnerabilities that greatly damage organizations – whether financially, reputationally, or through the release of classified information. Consequently, efforts to combat this fraud must evolve to become more sophisticated with each passing day. The field of fraud analytics is rapidly emerging and, over the past 10 years, has expanded to include graph analytics as a critical method for detecting suspicious behavior.  In one such application, a national agency overseeing insurance claims engaged EK to advise on developing and implementing graph-based analytics to support fraud detection. The agency had a capable team of data scientists, program analysts, and engineers focused on identifying suspicious activity among insurance claims, such as: Personal information being reused across multiple claims; Claims being filed under the identities of deceased individuals; or Individuals claiming insurance from multiple locations.