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SUGI26PredictiveModelingintheInsuranceIndustry-SAS
Advanced Tutorials
Paper 13-26
Predictive Modeling in the Insurance Industry Using SAS Software
Terry J. Woodfield, Ph.D., SAS Institute Inc., Irvine, CA
ABSTRACT CLAIMANT FRAUD
Insurance companies, third party insurance administrators, state When a worker is injured while performing the duties of his or her
insurance funds, state regulatory agencies, insurance industry job, the nature of the workers’ compensation insurance system
consultants, and application service providers (ASP) use SAS assumes liability of the employer while also placing limits of
software in a variety of predictive modeling situations. SAS liability depending on the circumstances. The injured party
Enterprise Miner provides tools for modeling continuous
whose accident is covered by an insurance policy is called the
responses, such as monetary losses and time off work, and
claimant. A claimant can commit fraud in a number of ways. The
discrete responses, such as fraud, third party subrogation, and
litigation. Enterprise Miner includes a rich set of menu driven claimant can fake an accident. The claimant can exaggerate the
modeling solutions as well as an underlying array of SAS severity of the injury. The claimant can misrepresent the injury
procedures for modeling insurance data. This paper will address to presume coverage, such as the worker who breaks a leg skiing
two problems, predicting losses and detecting fraud. Two on Sunday, then reports to work on Monday and within a few
possible solutions will be presented for each problem, and minutes claims to
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