Fraudulent Health Insurance Claims Detection using Machine Learning

Registration ID: IJNRD_215112

Published ID: IJNRD2403370

DOI: Click Here to Get

Harika Gudibandi , G.Mahi Durga Lakshmi , J.Pavaneeth , G.Bhargav Ram , Ch.Lalitha Syama Sundari

Health insurance fraud harm the integrity and long-term viability of global healthcare systems. With the expanding use of digital technology and electronic health records, there is a greater need for effective fraud detection tools to defend against financial losses and assure the quality of service. This review paper provides a comprehensive summary of current research on detecting false health insurance claims utilising machine learning approaches. This paper discusses a variety of methodology, including supervised and unsupervised learning algorithms, feature engineering techniques, anomaly detection methods, and ensemble learning approaches. It examines the issues of imbalanced datasets, noisy data, and model interpretability, as well as techniques for overcoming them.This research also assesses the effectiveness of machine learning models in detecting false health insurance claims utilizing real-world datasets and performance measurements such as accuracy, precision, recall, and F1 score. We hope that this poll will provide useful insights into the present status of research in this subject, as well as indicate future research directions to improve healthcare fraud detection systems.

Published Paper   E-Certificate

Harika Gudibandi, G.Mahi Durga Lakshmi, J.Pavaneeth, G.Bhargav Ram, & Ch.Lalitha Syama Sundari (March-2024). Fraudulent Health Insurance Claims Detection using Machine Learning. INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT, 9(3), d524-d533. https://ijnrd.org/papers/IJNRD2403370.pdf

Volume 9 Issue 3, March-2024

Pages : d524-d533

Paper Reg. ID: IJNRD_215112

Published Paper Id: IJNRD2403370

Downloads: 000121996

Research Area: Engineering

Country: Guntur, Andhra Pradesh, India

Published Paper PDF: https://ijnrd.org/papers/IJNRD2403370.pdf

Published Paper URL: https://ijnrd.org/viewpaperforall?paper=IJNRD2403370

Journal Name: INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT(IJNRD)

ISSN: 2456-4184 | IMPACT FACTOR: 8.76 Calculated By Google Scholar | ESTD YEAR: 2016

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