Abstract: Detection of insurance premium fraud is provided by a predictive model, which uses derived variables to assess the likelihood of fraud for each policy. The predictive model produces a score, which is a measure of the likelihood of premium fraud or abuse. The predictive model is included in a system that accepts policies to be considered for scoring, selects which policies are appropriate for scoring, stores data about the policies in a database, uses the data to derive variables for the model, and processes and outputs the model scores and related information. A rule-based analysis, which detects specific inconsistencies in the data that are indicative of premium fraud, may also be part of the system. The model scores and red-flag indicators from the rule-based analysis may be further processed to provide customized output for users.

Abstract: A system, computer program product, and method provide for reason driven data analysis in a web-based system that is configurable to various types of data and environments. The computer program product provides for navigation of a report tree of reports that are hierarchically organized with respect to reasons derived from an analysis of transactional data in a database. A frame based interface provides for easy and flexible navigation and configuration of the reports and other features. A configuration file is used to rapidly develop and customize the web-based system. Case management functionality is included to allow for management of cases being reviewed using the system.

Abstract: Computer implemented processes and software products generate profiles of entities, such as providers, clients, merchants and customers, and entities comprising interacting pairs of entities. The processes including deriving direct profiles from transaction data pertaining to an entity and enhancing the profile of one entity using the profile of another entity. Parallel and serial applications of the derive and enhance processes on various individual and multiple entites yields enhanced profiles that powerfully describe the interactions and relationship of the entities to each other, and between their members.