Social network analytics for supervised fraud detection in insurance

TL;DR

This paper presents a social network-based supervised learning approach for detecting insurance fraud, leveraging claim-related social connections and network features to improve detection accuracy.

Contribution

It introduces a novel method that combines social network analysis with supervised learning to enhance fraud detection in insurance claims.

Findings

Network features improve fraud detection accuracy.

Models with combined features outperform classical claim-only models.

The approach effectively flags suspicious claims for further investigation.

Abstract

Insurance fraud occurs when policyholders file claims that are exaggerated or based on intentional damages. This contribution develops a fraud detection strategy by extracting insightful information from the social network of a claim. First, we construct a network by linking claims with all their involved parties, including the policyholders, brokers, experts, and garages. Next, we establish fraud as a social phenomenon in the network and use the BiRank algorithm with a fraud specific query vector to compute a fraud score for each claim. From the network, we extract features related to the fraud scores as well as the claims' neighborhood structure. Finally, we combine these network features with the claim-specific features and build a supervised model with fraud in motor insurance as the target variable. Although we build a model for only motor insurance, the network includes claims from all available lines of business. Our results show that models with features derived from the network perform well when detecting fraud and even outperform the models using only the classical claim-specific features. Combining network and claim-specific features further improves the performance of supervised learning models to detect fraud. The resulting model flags highly suspicions claims that need to be further investigated. Our approach provides a guided and intelligent selection of claims and contributes to a more effective fraud investigation process.