System for dynamic fraud detection

A method to administer a data sharing architecture for a network of computers to perform insurance fraud detection for an insurance claim processing system, comprising:

• receiving, by a communication device, data indicative of a plurality of insurance claims submitted in connection with insurance policies;
• storing, by a computer storage unit, said data indicative of the plurality of insurance claims;
• automatically determining, by a fraud detection platform processor, that a first insurance claim is associated with a first type of insurance and that a second insurance claim is associated with a second type of insurance different from the first type of insurance,
• analyzing the received data associated with the first insurance claim, by the fraud detection platform processor in accordance with first fraud detection logic, to calculate an indicator strength score for the insurance claim,
• based on the indicator score for the first insurance claim, determining a first questionable loss status appropriate for the first insurance claim, wherein the first questionable loss status comprises one of:
• (i) an unlikely questionable loss that is not automatically referred to a special investigation unit platform, (ii) a likely questionable loss that is automatically referred to the special investigation unit platform, and (iii) a potential questionable loss that is flagged for further review by a claim handler,
• analyzing the received data associated with the second insurance claim, by the fraud detection platform processor in accordance with second fraud detection logic different from the first fraud detection logic, to determine a second questionable loss status appropriate for the second insurance claim;
• and
• transmitting indications of the first and second questionable loss statuses from the fraud detection platform processor.

A system for insurance fraud detection, comprising:

• a communication device to receive data indicative of a plurality of insurance claims submitted in connection with insurance policies;
• a computer storage unit for receiving, storing, and providing said data indicative of the plurality of insurance claims;
• and
• a fraud detection platform processor in communication with the storage unit, wherein the processor is configured for:
• automatically determining that a first insurance claim is associated with a first type of insurance and that a second insurance claim is associated with a second type of insurance different from the first type of insurance,
• analyzing the received data associated with the first insurance claim, in accordance with first fraud detection logic, to determine a first questionable loss status appropriate for the first insurance claim,
• analyzing the received data associated with the second insurance claim, in accordance with second fraud detection logic different from the first fraud detection logic, to determine a second questionable loss status appropriate for the second insurance claim, and
• transmitting indications of the first and second questionable loss statuses, wherein the first questionable loss status comprises one of:
• (i) an unlikely questionable loss that is not automatically transmitted to a special investigation unit platform, (ii) a likely questionable loss that is automatically transmitted to the special investigation unit platform, and (iii) a potential questionable loss that is flagged for further review by a claim handler.