Insurance Claims Fraud: Optimal Auditing Strategies in Insurance Companies

Détails

ID Serval
serval:BIB_02B5BF60B3C6
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Insurance Claims Fraud: Optimal Auditing Strategies in Insurance Companies
Périodique
Variance
Auteur⸱e⸱s
Müller K., Schmeiser H., Wagner J.
ISSN
1940-6444
Statut éditorial
Publié
Date de publication
2018
Peer-reviewed
Oui
Volume
10
Numéro
2
Pages
204-226
Langue
anglais
Résumé
Insurance claims fraud is one of the major concerns in the insurance industry. According to many estimates, excess payments due to fraudulent claims account for a large percentage of the total payments affecting all classes of insurance. In this study, we develop a model framework based on a costly state verification setting in which, while policyholders observe the amount of loss privately, the insurance company can decide to audit incoming claims at some cost. In particular, optimization problems are formulated from both stakeholders' positions considering that for each of them willing to sign an insurance contract, certain participation constraints need to be fulfilled. Besides deriving analytical solutions regarding optimal auditing strategies, we provide a numerical approach based on Monte Carlo methods. The simulation results illustrate the acceptance range that consists of all valid fraud and auditing probability combinations both stakeholders are willing to tolerate. We discuss the impact of different valid probability combinations on the insurance company's and policyholder's objective quantities respectively and analyze the sensitivity of the acceptance range with respect to different input parameters.
Mots-clé
Claims auditing, Costly state verification, Monte Carlo simulation
Création de la notice
07/01/2016 15:44
Dernière modification de la notice
21/08/2019 5:12
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