Secure communications

A system, comprising:

• one or more memory devices to store a plurality of rules for detecting fraud;
• and
• one or more processors to:
• receive a first plurality of claims;
• apply, in real time or near real time, the plurality of rules to the first plurality of claims based on receiving the first plurality of claims;
• generate, in real time or near real time, a plurality of alarms based on applying the plurality of rules to the first plurality of claims,
• the plurality of alarms being generated based on a fraud detector unit transmitting the first plurality of claims to a rules engine, the rules engine applying the plurality of rules to the first plurality of claims, and the rules engine generating, based on applying the plurality of rules, the plurality of alarms,
• a first alarm, of the plurality of alarms, being generated based on a first claim, of the first plurality of claims, and a second claim, of the first plurality of claims, that satisfy at least one rule of the plurality of rules,
• the second claim being different from the first claim,
• a second alarm, of the plurality of alarms, being generated based on a third claim, of the first plurality of claims, that satisfies at least one other rule of the plurality of rules,
• the second alarm being different from the first alarm,
• the third claim being different from the first claim and the second claim,
• a third alarm, of the plurality of alarms, being generated based on at least one of the first claim, the second claim, or the third claim,
• the third alarm being different from the first alarm and the second alarm;
• form, in real time or near real time, a first case, associated with the first claim, by combining the first alarm and the second alarm based on an attribute of two or more of the first claim, the second claim, or the third claim,
• the first case being formed by an alarm combiner and analyzer unit receiving the first alarm and the second alarm, analyzing the attribute, and forming the first case based on the analyzed attribute;
• determine, in real time or near real time, a first case score associated with the first case,
• the first case score being determined based on a fraud score generator unit receiving, from the alarm combiner and analyzer unit, information associated with the first case, analyzing the information associated with the first case, and determining the first case score based on analyzing the information associated with the first case;
• form, in real time or near real time, a second case, associated with the first claim, based on the third alarm,
• the second case being formed by the alarm combiner and analyzer unit receiving the third alarm, analyzing an attribute associated with the third alarm, and forming the second case based on the analyzed attribute associated with the third alarm;
• determine, in real time or near real time, a second case score associated with the second case,
• the second case score being determined based on the fraud score generator unit receiving, from the alarm combiner and analyzer unit, information associated with the second case, analyzing the information associated with the second case, and determining the second case score based on analyzing the information associated with the second case;
• determine, in real time or near real time, a fraud score, for the first claim, based on the first case score and the second case score;
• selectively apply, in real time or near real time, predictive modeling to information associated with the first claim to determine whether the first claim is fraudulent,
• the predictive modeling being selectively applied based on whether the fraud score satisfies a threshold score, and
• when the predictive modeling is applied, applying the predictive modeling including using a streaming data reduction platform to normalize and filter the information associated with the first claim to reduce the information associated with the first claim to a size that may be processed in real time or near real time;
• provide, based on selectively applying the predictive modeling, an indication associated with the first claim,
• the indication associated with the first claim being provided in real time or near real time to a claims processor device, and causing at least one of:
• acceptance of the first claim prior to payment of the first claim by the claims processor device, or
• denial of the first claim prior to payment of the first claim by the claims processor device;
• receive, in real time or near real time, a second set of one or more claims;
• selectively apply, in real time or near real time, the predictive modeling to information associated with the second set of one or more claims to determine whether the first claim is fraudulent;
• and
• update, based on selectively applying the predictive modeling to the information associated with the second set of one or more claims and in real time or near real time, the indication associated with the first claim.

A non-transitory computer-readable medium storing instructions, the instructions comprising:

• one or more instructions that, when executed by one or more processors, cause the one or more processors to:
• receive a first plurality of claims;
• apply, in real time or near real time, a plurality of rules to the first plurality of claims based on receiving the first plurality of claims;
• generate, in real time or near real time, a plurality of alarms based on applying the plurality of rules to the first plurality of claims,
• the plurality of alarms being generated based on a fraud detector unit transmitting the first plurality of claims to a rules engine, the rules engine applying the plurality of rules to the first plurality of claims, and the rules engine generating, based on applying the plurality of rules, the plurality of alarms,
• a first alarm, of the plurality of alarms, being generated based on a first claim, of the first plurality of claims, and a second claim, of the first plurality of claims, that satisfy at least one rule of the plurality of rules,
• the second claim being different from the first claim,
• a second alarm, of the plurality of alarms, being generated based on a third claim, of the first plurality of claims, that satisfies at least one other rule of the plurality of rules,
• the second alarm being different from the first alarm,
• the third claim being different from the first claim and the second claim,
• a third alarm, of the plurality of alarms, being generated based on at least one of the first claim, the second claim, or the third claim,
• the third alarm being different from the first alarm and the second alarm;
• form, in real time or near real time, a first case, associated with the first claim, by combining the first alarm and the second alarm based on an attribute of two or more of the first claim, the second claim, or the third claim,
• the first case being formed by an alarm combiner and analyzer unit receiving the first alarm and the second alarm, analyzing the attribute, and forming the first case based on the analyzed attribute;
• determine, in real time or near real time, a first case score associated with the first case,
• the first case score being determined based on a fraud score generator unit receiving, from the alarm combiner and analyzer unit, information associated with the first case, analyzing the information associated with the first case, and determining the first case score based on analyzing the information associated with the first case;
• form, in real time or near real time, a second case, associated with the first claim, based on the third alarm,
• the second case being formed by the alarm combiner and analyzer unit receiving the third alarm, analyzing an attribute associated with the third alarm, and forming the second case based on the analyzed attribute associated with the third alarm;
• determine, in real time or near real time, a second case score associated with the second case,
• the second case score being determined based on the fraud score generator unit receiving, from the alarm combiner and analyzer unit, information associated with the second case, analyzing the information associated with the second case, and determining the second case score based on analyzing the information associated with the second case;
• determine, in real time or near real time, a fraud score, for the first claim, based on the first case score and the second case score;
• selectively apply, in real time or near real time, predictive modeling to information associated with the first claim to determine whether the first claim is fraudulent,
• the predictive modeling being selectively applied based on whether the fraud score satisfies a threshold score, and
• when the predictive modeling is applied, applying the predictive modeling including using a streaming data reduction platform to normalize and filter the information associated with the first claim to reduce the information associated with the first claim to a size that may be processed in real time or near real time;
• and
• provide, based on selectively applying the predictive modeling, an indication associated with the first claim,
• the indication associated with the first claim being provided in real time or near real time to a claims processor device, and causing at least one of:
• acceptance of the first claim prior to payment of the first claim by the claims processor device, or
• denial of the first claim prior to payment of the first claim by the claims processor device;
• receive, in real time or near real time, a second set of one or more claims;
• selectively apply, in real time or near real time, the predictive modeling to information associated with the second set of one or more claims to determine whether the first claim is fraudulent;
• and
• update, based on selectively applying the predictive modeling to the information associated with the second set of one or more claims, and in real time or near real time, the indication associated with the first claim.