Using CommonKADS Method to Build Prototype System in Medical Insurance Fraud Detection

@article{Tsai2014UsingCM,
  title={Using CommonKADS Method to Build Prototype System in Medical Insurance Fraud Detection},
  author={Yao-Hsu Tsai and Chieh-Heng Ko and K. Lin},
  journal={J. Networks},
  year={2014},
  volume={9},
  pages={1798-1802}
}
At present, the false claim cases related to insurance fraud emerge endlessly. [...] Key Method We employ a knowledge engineering methodology to analyze problems and construct knowledge modesl, including the domain schema and rules. We implement the knowledge model along with the existing database applications. The benefits generated by the research are: (1) establishing a knowledge system with expertise reasoning to solve the review problems of massive cases, (2) significantly reducing the large labor cost and…Expand
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References

SHOWING 1-10 OF 33 REFERENCES
INSURANCE FRAUD
  • 116
  • PDF
Statistical fraud detection: A review
  • 1,053
  • PDF
Auditing claims in the insurance market with fraud: The credibility issue
  • 170
  • PDF
A PRIVATE NETWORK OF SOCIAL CONTROL: INSURANCE INVESTIGATION UNITS*
  • 23
Knowledge Engineering and Management: The CommonKADS Methodology
  • 1,737
Controlling software projects
  • P. Rook
  • Engineering, Computer Science
  • Softw. Eng. J.
  • 1986
  • 314
UML - A Universal Modeling Language?
  • 45
  • PDF
...
1
2
3
4
...