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Fraud Detection in Insurance Claims 

Group Mambers

  • Prince Boateng
  • Sandra Ngoing

Project Overview

The project focuses on fraud detection and risk assessment in insurance claims. The primary objectives are:

  • Fraud Detection – Identifying fraudulent claims efficiently to minimize financial losses.
  • Risk Assessment – Analyzing patterns in incidents and claims to improve risk evaluation and resource allocation. The dataset includes customer demographics, policy details, incident information, and claims data, with a specific fraud_reported variable for fraud detection.

Hypothesis

  • Fraudulent claims may be more frequent in certain age groups and specific locations.
  • Incidents might be more common during certain times, such as rush hours or late evenings.

Challenges and Solutions

  • Missing Data – Handled using statistical methods.
  • Inconsistent Formats – Standardized date/time formats.
  • Duplicate Entries – Identified and removed.

Key Findings

  • High claim amounts often correlate with higher fraud likelihood.
  • Fraud detection models can help insurers adjust policies dynamically.
  • Risk-based pricing models can be implemented to charge higher premiums for high-risk customers while offering discounts to low-risk customers.

Conclusion

  • Developing a machine learning model to predict fraud can improve detection efficiency.
  • Dynamic pricing models can enhance profitability by attracting low-risk customers.
  • Insurance claims exhibit randomness, making precise predictions challenging.

Major Obstacle

Difficulty in importing data into an SQL database, which highlighted the importance of matching data types.

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