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Insurance fraud detection with unsupervised deep learning

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  • Chamal Gomes
  • Zhuo Jin
  • Hailiang Yang

Abstract

The objective of this paper is to propose a novel deep learning methodology to gain pragmatic insights into the behavior of an insured person using unsupervised variable importance. It lays the groundwork for understanding how insights can be gained into the fraudulent behavior of an insured person with minimum effort. Starting with a preliminary investigation of the limitations of the existing fraud detection models, we propose a new variable importance methodology incorporated with two prominent unsupervised deep learning models, namely, the autoencoder and the variational autoencoder. Each model's dynamics is discussed to inform the reader on how models can be adapted for fraud detection and how results can be perceived appropriately. Both qualitative and quantitative performance evaluations are conducted, although a greater emphasis is placed on qualitative evaluation. To broaden the scope of reference of fraud detection setting, various metrics are used in the qualitative evaluation.

Suggested Citation

  • Chamal Gomes & Zhuo Jin & Hailiang Yang, 2021. "Insurance fraud detection with unsupervised deep learning," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 88(3), pages 591-624, September.
  • Handle: RePEc:bla:jrinsu:v:88:y:2021:i:3:p:591-624
    DOI: 10.1111/jori.12359
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    References listed on IDEAS

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    Cited by:

    1. Spark C. Tseung & Ian Weng Chan & Tsz Chai Fung & Andrei L. Badescu & X. Sheldon Lin, 2022. "A Posteriori Risk Classification and Ratemaking with Random Effects in the Mixture-of-Experts Model," Papers 2209.15212, arXiv.org.
    2. Alexander Vosseler, 2022. "Unsupervised Insurance Fraud Prediction Based on Anomaly Detector Ensembles," Risks, MDPI, vol. 10(7), pages 1-20, June.
    3. Michele Tumminello & Andrea Consiglio & Pietro Vassallo & Riccardo Cesari & Fabio Farabullini, 2023. "Insurance fraud detection: A statistically validated network approach," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 90(2), pages 381-419, June.
    4. Angela Zeier Röschmann & Matthias Erny & Joël Wagner, 2022. "On the (future) role of on-demand insurance: market landscape, business model and customer perception," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 47(3), pages 603-642, July.
    5. Daniel Bauer & James Tyler Leverty & Joan Schmit & Justin Sydnor, 2021. "Symposium on insure‐tech, digitalization, and big‐data techniques in risk management and insurance," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 88(3), pages 525-528, September.
    6. Xiao Lin & Mark J. Browne & Annette Hofmann, 2022. "Race discrimination in the adjudication of claims: Evidence from earthquake insurance," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 89(3), pages 553-580, September.
    7. Chih-Te Yang & Yensen Ni & Mu-Hsiang Yu & Yuhsin Chen & Paoyu Huang, 2023. "Decoding the Profitability of Insurance Products: A Novel Approach to Evaluating Non-Participating and Participating Insurance Policies," Mathematics, MDPI, vol. 11(13), pages 1-16, June.
    8. Serkan Eti & Hasan Dinçer & Hasan Meral & Serhat Yüksel & Yaşar Gökalp, 2024. "Insurtech in Europe: identifying the top investment priorities for driving innovation," Financial Innovation, Springer;Southwestern University of Finance and Economics, vol. 10(1), pages 1-24, December.
    9. Aslam, Faheem & Hunjra, Ahmed Imran & Ftiti, Zied & Louhichi, Wael & Shams, Tahira, 2022. "Insurance fraud detection: Evidence from artificial intelligence and machine learning," Research in International Business and Finance, Elsevier, vol. 62(C).

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