Verfahren und System zur Identifizierung von Betrug in Nicht-Arbeitenden Versicherungsansprüchen unter Verwendung eines Hybridgewichteten Entscheidungsmodells

Details

Veröffentlichungs-Nr.

EP4730251

Anmeldetag

20. Oktober 2025

Veröffentlichung

22. April 2026

Rechtsraum

EP

IPC

G06Q40/08

Abstract

This disclosure relates generally to method and system for identifying frauds in unemployment insurance claims using hybrid weighted decision model. The method combines predictive power of machine learning models with domain knowledge infused key fraud indicators and network analysis to identify false positive claims. Initially, a set of claim information from a request of a claimant is extracted to assess risk affecting eligibility of the claimant to receive benefits. Further, a classification probability for a set of key fraud indicators are predicted for each claim using a set of top features associated with a prescient artificial intelligence (AI) model. Finally, one or more frauds associated with the unemployment insurance claim of the claimant are identified based on the weighted probability of each claim, a network diagram generated using the weighted probability for each claim, a set of filtered claims, and a set of business rules.

Anmelder

Firma

Tata Consultancy Services Limited

Land

🇮🇳 Indien