AU2021101568A4 - Artificial intelligence and big data analytics based insurance service fraud detection system - Google Patents

Abstract

ARTIFICIAL INTELLIGENCE AND BIGDATA ANALYTICS BASED INSURANCE SERVICE FRAUD DETECTION SYSTEM The present invention relates to artificial intelligence based insurance service fraud detection system using big data analysis. Said fraud detection system (1) comprises of an application software for user interface devices (3) in which the Insurance document issued by an agent (4) are uploaded in the form of image by a user (2). The interface devices (3) are connected with a database (31) which comprises of an artificial intelligence server (11). Said artificial intelligence server (11) is connected with an insurance authority council database server (32) and a financial institution database server (33). This system helps to inspect the insurance documents and the Insurance agent. STARTRD Useruploads the insurance details using the interface application Artificial Intelligence analyses the uploaded details Verifying the uploaded details from databases Sending alert tousrabutN Authorized fraudulent agent Agent ? Yes Sending notification to user NoRight - regarding insurance NoInsurance scheme issued scheme issued Yes Sending notification to user No Amount credit regarding non crediting of to specific premium to specific account ? account Yes User sends an alert message with details of falsification to the Sending notification to user about issued insurance insurance authority council is correct database. SENDD FIG- 3 3

Description

STARTRD

Useruploads the insurance details using the interface application

Artificial Intelligence analyses the uploaded details

Verifying the uploaded details from databases

Sending alert tousrabutN Authorized fraudulent agent Agent ?

Yes

Sending notification to user NoRight - regarding insurance NoInsurance scheme issued scheme issued

Yes Sending notification to user No Amount credit regarding non crediting of to specific premium to specific account ? account

Yes User sends an alert message with details of falsification to the Sending notification to user about issued insurance insurance authority council is correct database.

SENDD

FIG- 3

ARTIFICIAL INTELLIGENCE AND BIG DATA ANALYTICS BASED INSURANCE SERVICE FRAUD DETECTION SYSTEM FIELD OF THE INVENTION

[001] The present invention relates to the field of Artificial Intelligence and

Big data analysis in the area of financial services. More particularly, the

present invention relates to artificial intelligence based insurance service

fraud detection system using Big data analysis.

BACKGROUND OF THE INVENTION

[002] Insurance play an important role in protecting buyers of insurance

policies from financial loss. Various kinds of insurance policies may be

offered by insurance companies (insurers) that may include health insurance,

automobile insurance, etc. The buyers may seek insurance claims, in view of

an incurred or impending financial expense. As it will be appreciated by

those skilled in the art, the financial expense may be towards treatment of a

health condition, repairing or maintenance of an automobile, etc.

[003] An insurance company agent or a third party agents sells the policy to

the buyer. At time of purchasing the policy there are possibilities that the

buyer may not be fully acknowledged about the details of the policy by the

agents. Though the buyer pays for the policy it is important that he/she shall

be able to verify the policy details. There are certain incidents where the

insurance policy document given to the buyer turn out to be false. Said buyer may know regarding it at later stage or probably at time of claim. Therefore, it is important to detect the insurance document for any falsification. However, the premium paid for the insurance policy may not be credited to respective insurance company financial account. Hence a system is required which provides a fraud detection in insurance service and alerts the insurance authority.

[004] There are some inventions proposed in the existing invention which

may resolve the above said issue. The existing invention provides a system

for reducing fraud and risks in insurance. The existing inventions proposed to

resolve the above said issue are disclosed in the prior art sections. An Indian

patent application 201917025756 describes a system and method for

providing trade insurance and finance. The system comprises a central

controller arranged in communication with one or more databases to

electronically obtain information from the databases, wherein the information

includes an invoice, and a block chain hub operationally connected to the

central controller for circulating the information from the central controller to

one or more platforms. The block chain hub, which bills of lading are also

encoded and verified, is capable of generating a hash response output

based on a request from the one or more platforms, and wherein if the

invoice meets at least one pre-determined criterion, the central controller

provides the invoice to an insurer for insurance and a lender for financing the

invoice. Though the invention provides a system to reduce the fraud in insurance service but is more specific to the field of trade and financing.

Moreover, it doesn't provide a method to detect the insurance fraud.

[005] A US patent application US7813944 describes a system for detection

of insurance premium fraud 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. Though the invention provides a system for detection of insurance

premium fraud but doesn't provide a system to detect other details of an

insurance.

[006] A Korean patent application KR20200029426 describes a device and

method for detecting an unfair insurance claim and an unfair pattern based

on artificial intelligence comprises a data pre-processing unit standardizing

insurance claim data to derive characteristic variables; an outlier detection unit detecting a normal pattern and an unfair pattern from the detected outlier cluster based on an outlier detection algorithm using the characteristic variable as an input; a new pattern classification unit detecting the new pattern of unfair claims by performing unsupervised learning using the normal pattern and the unfair pattern as inputs; and an unfair claim determination unit determining whether or not new insurance claims are fair by constructing a supervised learning based unfair claim detection model using the characteristic variables and normal claim data as inputs. Though the invention provides a device and method to detect unfair claim and an unfair pattern but doesn't provide a method for detecting fraud in insurance policy document.

[007] There are no existing inventions in the existing art which provides a

common system for verification of the insurance policy document.

Furthermore, there are no way for alerting the insurance authority council

regarding the insurance service fraud. Moreover, the present invention

overcomes the shortcomings of the existing arts.

OBJECTIVE OF THE INVENTION

[008] The principal objective of the present invention is to solve the

fraudulence related problems persists in the Insurance industry by providing

an investigation system.

[009] Another objective of the present invention is to provide an artificial

intelligence and big data analysis based fraud detection system for insurance

service.

[010] Another objective of the present invention is to provide an interface for

users to verify an insurance policy document.

[011] Another objective of the present invention is to use the interface to

alert the fraud related issues immediately to insurance authority council.

[012] Other objectives and advantages of the present disclosure will be

more apparent from the following description, which is not intended to limit

the scope of the present disclosure.

SUMMARY OF THE INVENTION

[013] The following presents a simplified summary of the invention in order

to provide a basic understanding of some aspects of the invention. This

summary is not an extensive overview of the present invention. It is not

intended to identify the key/critical elements of the invention or to delineate

the scope of the invention. Its sole purpose is to present some concept of the

invention in a simplified form as a prelude to a more detailed description of

the invention presented later.

[014] According to the main aspect of the present invention, an artificial

intelligence and big data analytics based insurance service fraud detection

system wherein said system comprises of a user with an interface device, an

agent and plurality of insurance companies. Said fraud detection system

comprises of an artificial intelligence server, a user database, an insurance

authority council database and a financial institution database. Said artificial

intelligence server is employed to identify and sort the data of plurality of

insurance companies. Said artificial intelligence server is employed for

processing insurance document. Said artificial intelligence server is provided

with an artificial intelligence processor, an artificial intelligence memory unit,

an artificial intelligence algorithm and a transmitter/reception unit. Said

artificial intelligence server comprises of dedicated databases, said database

consists of user database, an insurance authority council database and a

financial institution database.

[015] According to the method of operation of the present invention of the

artificial intelligence for insurance service fraud detection system, said fraud

detection system involves the following steps. The user uploads insurance

document to user database using an application in interface device. The

artificial intelligence server decodes the insurance document uploaded by the

user and analyzing the data from user database. Said server sorts the details

in the insurance document such as Agent details, Premium paid, scheme

offered and insurance company. The artificial intelligence server is initiated to

verify, analyze and compare the decoded details in the dedicated database.

The artificial intelligence server verifies the Agent details with the data

present in the insurance authority council database. Said artificial intelligence

server verifies and compares the scheme details with the data present in the

insurance authority council database. Said artificial intelligence server

analyses the premium credited in the financial institution database for a

specific insurance company using. Said server sends the verification result

as a notification to user interface device from user database. The user sends

an alert message with details if verification results in falsification to the

insurance authority council database using the user interface application.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and other aspects, features and advantages of certain exemplary

embodiment of the present invention will be more apparent from the following

description taken in conjunction with the accompanying drawings in which:

[016] Figure 1 illustrates the artificial intelligence based insurance service

fraud detection system according to the main aspect of the present invention.

[017] Figure 2 depicts the block diagram of artificial intelligence server

according to the present invention.

[018] Figure 3 depicts the flowchart representation of fraud detection

system according to the present invention.

DETAILED DESCRIPTION OF THE DRAWINGS

[019] Figure 1 illustrates the artificial intelligence based insurance service

fraud detection system according to the main aspect of the present invention.

An insurance service to a user (2) from an insurance company (20) is

provided through an insurance agent (4) which is commonly known in the

existing arts. The user (2) is a buyer of insurance policy from a respective

company. Said insurance agent (4) preferably a company agent or a third

party agent. The insurance to a user (2) may be provided by any of the

plurality of insurance companies (21, 22, 23, 24). Each of the plurality of

companies (21, 22, 23, 24) consists of an individual servers (21a, 22a, 23a,

24a) having data stored in each servers relevant to the each of the said

companies and said servers are linked to insurance authority council

database (32) and financial institution database (33). Said databases (32,

33) consists of plurality of companies (21, 22, 23, 24) details such as policy

details, number of agents, agent details, financial details with relevant

finance institute etc., and third party agent details. The user (2) consists of an

interface device (3) with an application. Said device (3) is connected to a

user database (31). The application in the user interface device (3) is used to

upload the data in the said user database (31). The fraud detection system

(1) uses an artificial intelligence server (11) to detect fraud by processing the

data from dedicated databases. Said server (11) is connected to user

database (31), insurance authority council (32) and financial institution

database (33). The artificial intelligence server (11) employs the big data

analysis for managing the respective databases.

[020] Figure 2 depicts the block diagram of artificial intelligence server

according to the present invention. The artificial intelligence server (11)

consists of an artificial intelligence processor (12), an artificial intelligence

memory unit (13), an artificial intelligence algorithm (14) and a

transmitter/reception unit (15) and inter connected with said artificial

intelligence processor (12). Said artificial intelligence memory unit (13) is

provided with the artificial intelligence algorithm (14). The algorithm (14) is

provided for big data analysis and fraud detection. Said processor (12) is

connected to user database (31), insurance authority council database (32)

and financial institution database (33) and said user database (31) is

connected to user interface device (3).

[021] Figure 3 depicts the flowchart representation of fraud detection

system according to the present invention. The insurance policy is bought by

a user (2) through an insurance agent (4). The user (2) may use the

application in the interface device (2) to verify the insurance policy document.

The verification process involves uploading the insurance document to user

database (31) using the application in the interface device (3) by the user (2).

The artificial intelligence server (11) is initiated to analyze, verify and

compare the insurance document details using big data analysis. Said server

(11) analyses the data by extracting the data through decoding the insurance

document uploaded in the user database (31). Further, the extracted data is

sorted according to details such as Name of the agent, Agent details, Period

of validity, premium paid, Scheme details and other relevant details present in the insurance document. The server (11) verifies the Agent details with the data present in the insurance authority council database (32).

Simultaneously the scheme details are verified and compared with the data

present in the insurance authority council database (32). The premium paid

and credited to relevant insurance company account is analyzed by artificial

intelligence server (11) with financial institution database (33). The result of

the verification is send as a notification to user interface device (3) from

artificial intelligence server (11) through user database (31). The user sends

an alert message with details if verification results in falsification to the

insurance authority council database using the user interface application (3).

[022] The present invention is advantageous as it provides an artificial

intelligence and big data analysis based fraud detection in insurance service.

Advantageously, the present invention helps to identify the details like, name

of the insurance provider, Name of the Agent, Insurance coverage, Cost of

Insurance and validity period using the insurance document. Moreover, the

invention provides an interface application for user to verify the policy

bought. Thereby detecting the fraud and also provides a way to alert the

insurance authority council regarding the fraud.

Claims (5)

WE CLAIM:

1. Artificial intelligence and big data analytics based insurance service

fraud detection system (1), said system comprising;

- An application software for user interface devices (3) in which the

Insurance document issued by an agent (4) are uploaded in the

form of image by a user (2);

- The interface devices (3) are connected with a database (31)

which comprises of an artificial intelligence server (11);

- Said artificial intelligence server (11) is connected with an

insurance authority council database server (32) and said

database server (32) is connected with plurality of the servers

(21a, 22a, 23a, 24a) of insurance companies (20); and,

- Said artificial intelligence server (11) is connected with financial

institution database server (33) and said database server (33) is

connected with plurality of the servers (21a, 22a, 23a, 24a) of

insurance companies (20).

2. The Insurance service fraud detection system as claimed in claim 1,

characterized in that, said artificial intelligence server (11) is

provided with an artificial intelligence processor (12), a memory unit

(13), an artificial intelligence algorithm (14) and a transmitter/reception

unit (15).

3. The Insurance service fraud detection system as claimed in claim 1,

characterized in that, said artificial intelligence server (11) comprises

of dedicated databases such as user database (31), an insurance

authority council database (32) and a financial institution database

(33).

4. Artificial intelligence and big data analytics based insurance service

fraud detection system, said fraud detection system (1) comprises the

steps of;

- Uploading insurance document to user database (31) using an

application in interface device (3) by user (2);

- Decoding the insurance document uploaded by the user (2) and

analyzing the data by artificial intelligence server (11) in the user

database (31);

- Sorting the details in the insurance document such as Agent

details, Amount paid, scheme offered and insurance company;

- Initiating the artificial intelligence server (11) to verify, analyze and

compare the decoded details in the dedicated database;

- Verifying the Agent details with the data present in the insurance

authority council database (32) using said artificial intelligence

server (11);

- Verifying and comparing the scheme details with the data present

in the insurance authority council database (32) using said artificial

intelligence server (11);

- Analyzing the amount credited in the financial institution database

(33) for a specific insurance company using said artificial

intelligence server (11);

- Sending the verification result as a notification to user interface

device (3) from user database (31);

- Sending an alert message with details if verification results in

falsification to the insurance authority council database (32) using

the user interface application (3) by user (2).

5. The Insurance service fraud detection system and the method as

claimed in claim 1 and 4, characterized in that, the details such as

name of the insurance provider, Name of the Agent, Insurance

coverage, Cost of Insurance and validity period of the insurance

document are obtained by the user interface application.

FIG -1

FIG- 2

FIG- 3