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用于预测和预防医疗保险索赔处理错误的数据挖掘Data Mining to Predict and Prevent Errors in Health Insurance Claims Processing |
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| 课程网址: | http://videolectures.net/kdd2010_kumar_dmppeh/ |
| 主讲教师: | Mohit Kumar |
| 开课单位: | 卡内基梅隆大学 |
| 开课时间: | 2010-10-01 |
| 课程语种: | 英语 |
| 中文简介: |  |
| 课程简介: | Health insurance costs across the world have increased alarmingly in recent years. A major cause of this increase are payment errors made by the insurance companies while processing claims. These errors often result in extra administrative effort to re-process (or rework) the claim which accounts for up to 30% of the administrative staff in a typical health insurer. We describe a system that helps reduce these errors using machine learning techniques by predicting claims that will need to be reworked, generating explanations to help the auditors correct these claims, and experiment with feature selection, concept drift, and active learning to collect feedback from the auditors to improve over time. We describe our framework, problem formulation, evaluation metrics, and experimental results on claims data from a large US health insurer. We show that our system results in an order of magnitude better precision (hit rate) over existing approaches which is accurate enough to potentially result in over $15-25 million in savings for a typical insurer. We also describe interesting research problems in this domain as well as design choices made to make the system easily deployable across health insurance companies. |
| 关 键 词: | 医疗保险; 概念漂移; 保险公司 |
| 课程来源: | 视频讲座网 |
| 最后编审: | 2019-05-11：lxf |
| 阅读次数: | 79 |