Abstract: A computer system includes a data storage module which receives, stores, and provides access to determinate data, raw indeterminate data, and extracted indeterminate data captured by an indeterminate data capture module. The computer system also includes a computer processor, a model training component, and a screening module. The model training component generates the predictive model based upon historical determinate and indeterminate data, and continuously adapts the predictive model with new historical data. The screening module categorizes current claims according to whether they are suitable for predictive analysis by the predictive model. The predictive model is applied to the current claims suitable for predictive analysis to determine a value for each claim indicative of whether the current claim transaction is questionable. The system also includes an output device which outputs the determined value for each claim, and a routing modules which routes claim workflow based on the outputted values.

Abstract: A computer system includes a data storage module which receives, stores, and provides access to determinate data, raw indeterminate data, and extracted indeterminate data captured by an indeterminate data capture module. The computer system also includes a computer processor, a model training component, and a screening module. The model training component generates the predictive model based upon historical determinate and indeterminate data, and continuously adapts the predictive model with new historical data. The screening module categorizes current claims according to whether they are suitable for predictive analysis by the predictive model. The predictive model is applied to the current claims suitable for predictive analysis to determine a value for each claim indicative of whether the current claim transaction is questionable. The system also includes an output device which outputs the determined value for each claim, and a routing modules which routes claim workflow based on the outputted values.

Abstract: A computer system includes a data storage module. The computer system also includes an indeterminate data capture module. The data storage module receives, stores, and provides access to both determinate data and indeterminate data that was captured by the indeterminate data capture module. The computer system also includes a computer processor and a program memory. The computer processor executes programmed instructions and stores and retrieves the data stored in the data storage module. The data stored in the data storage module is related to historical claim transactions and current claim transactions. A predictive model component is coupled to the data storage module, and determines whether to refer a current claim transaction to an investigation unit. A model training component is coupled to the computer processor and functions to train the predictive model.

Abstract: A computer system includes a data storage module. The computer system also includes an indeterminate data capture module. The data storage module receives, stores, and provides access to both determinate data and indeterminate data that was captured by the indeterminate data capture module. The computer system also includes a computer processor and a program memory. The computer processor executes programmed instructions and stores and retrieves the data stored in the data storage module. The data stored in the data storage module is related to historical claim transactions and current claim transactions. A predictive model component is coupled to the data storage module, and determines whether to refer a current claim transaction to an investigation unit. A model training component is coupled to the computer processor and functions to train the predictive model.