EXL EQ 2019

TEAM OPTIMUM
(IIT KHARAGPUR)
INDICATOR RATING
COST CUT
HISTORICAL
EFFICIENCY
PRODUCT
ACCURACY
BEHAVIOURAL
LOSS REDUCTION
SOCIAL
FALSE NEGATIVE
PERSONAL &
FINANCIAL

CLAIM

CUMULATIVE FRAUD RATING

1 10
 Eventuality
Polygraphic Test

Phone audio lie detection

RNN classifier

Policy Issuing Assessment

Website Interaction Willingness to share

information
Click & time duration
LSTM classification BEHAVIOURAL Text mining for hit
words
Psychometric Test
score Post claim
Removal of entities

BEHAVIOURAL
Cluster Analysis
FRAUD SCORE
 INDICATORS METHODOLOGY ESTIMATE SOCIAL
Social Network Represent relations as network

Analysis Apply social network algorithm Probability of fraud Clustering

Fraud vs Normal classification
Algorithm

Reference Survey based analysis Categorical Responses

information
Likert and Nominal Scale
collection

Define suspicious rules Count of Violations

Social Media
Activity Monitor violations on platforms
SOCIAL
FRAUD SCORE
 CLAIM PRODUCT
Expected Life

Documents Records

Age Type

CLAIM FRAUD Trained self learning algorithm PRODUCT

SCORE FRAUD SCORE
 HISTORICAL
Number of Premium payment pattern
Claim records criminal charges (inflated payments)

Background Verification
Credit history Inter insurers information exchange
(CIBIL Score) (Automated calls,
(anomalies reported) Speech to text,
Sentiment analysis)

Arithmetic Hierarchical Process

Weighted Average
HISTORICAL
FRAUD SCORE
PERSONAL FINANCIAL
Trained Classification
Algorithm

PERSONAL INSURANCE

> Income and sources of income

> Assets and Liabilities
> Expenditure
> Tax returns New user information on
> Bank statement analysis personal characteristics

COMMERCIAL INSURANCE

> Profitability ratios

> Leverage ratios

PERSONAL &
> Liquidity ratios
> Financial statement analysis

FINANCIAL
FRAUD SCORE
 AGGREGATE PROCESS FLOW

CLAIM DETAILS VALIDATION SCORING DASHBOARD

ANALYSIS COMPLIANCE RULES RESOURCE

ALLOCATION*

* ( RESOURCE ALLOCATED= f (CUMULATIVE FRAUD RATING, CLAIM SEVERITY)

RESOURCE ALLOCATION PERCENTAGE= 8*CUMULATIVE FRAUD RATING+2*SEVERITY )

DECISION: FRAUD CLAIM NON-FRAUD CLAIM