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Validating a Novel Health Insurance Fraud Detection Method
Validating a Novel Health Insurance Fraud Detection Method This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for ...- Authors: Robert D Lieberthal, Elias
- Date: Aug 2018
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Economics>Health economics; Enterprise Risk Management; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Public financing - Health & Disability; Modeling & Statistical Methods>Data mining; Predictive Analytics
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Estimating Probability of a Cyber-Security Breach
Estimating Probability of a Cyber-Security Breach The purpose of this paper is to define a predictive model, based on known system attributes, for assessing risk associated with information ...- Authors: Society of Actuaries, Arkady Shemyakin, Meghan Anthony, Maria Ishmael, Erik William Santa, Natalie Vandeweghe, Gary Stanull
- Date: Dec 2016
- Competency: Strategic Insight and Integration
- Publication Name: Risk Management
- Topics: Enterprise Risk Management; Health & Disability>Health information technology; Modeling & Statistical Methods>Bayesian methods; Predictive Analytics; Technology & Applications>Analytics and informatics
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Assessing Prescription Opioid Risk with Predictive Analytics
Assessing Prescription Opioid Risk with Predictive Analytics We highlight a new approach leveraging predictive analytics to identify high risk and rising risk opioid users for more effective ...- Authors: Joseph Boschert, Andrew Gaffner, Barbara Collier
- Date: Oct 2018
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; Leadership>Thought leadership; Professional Values>Practice expertise; Strategic Insight and Integration>Effective decision-making; Strategic Insight and Integration>Influence decisions; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Demography>Population data; Experience Studies & Data; Health & Disability>Health information technology; Modeling & Statistical Methods>Data mining; Predictive Analytics; Technology & Applications>Analytics and informatics; Health & Disability>Electronic medical record