Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Informing the development of a fraud prevention toolset through a situated analysis of fraud investigation expertise
AU - Ormerod, Thomas C.
AU - Ball, Linden J.
AU - Morley, Nicola J.
PY - 2012
Y1 - 2012
N2 - Insurance fraud is a growing problem. This article describes a project that aimed to specify and develop a suite of computer-based tools to support the early detection and subsequent investigation of potentially fraudulent claims. System requirements were informed by ethnographic studies focusing on: (1) understanding current fraud detection practices and (2) characterising fraud investigation expertise. Tools were designed that sift claims for potential problem cases and assist in the processes of investigation and detection of new fraud types by providing anomaly capture, argumentation and visualisation environments. The resulting tools capitalise upon expertise and embody processes that can subsequently be used by inexperienced claims handlers to detect and deal with fraudulent claims.
AB - Insurance fraud is a growing problem. This article describes a project that aimed to specify and develop a suite of computer-based tools to support the early detection and subsequent investigation of potentially fraudulent claims. System requirements were informed by ethnographic studies focusing on: (1) understanding current fraud detection practices and (2) characterising fraud investigation expertise. Tools were designed that sift claims for potential problem cases and assist in the processes of investigation and detection of new fraud types by providing anomaly capture, argumentation and visualisation environments. The resulting tools capitalise upon expertise and embody processes that can subsequently be used by inexperienced claims handlers to detect and deal with fraudulent claims.
KW - insurance fraud
KW - cognitive ethnography
KW - anomaly capture
KW - computer-based tools
KW - decision support systems
U2 - 10.1080/01449291003752906
DO - 10.1080/01449291003752906
M3 - Journal article
VL - 31
SP - 371
EP - 381
JO - Behaviour and Information Technology
JF - Behaviour and Information Technology
SN - 0144-929X
IS - 4
ER -