SmartWorks FDS
Intelligent Insurance Fraud Prevention System

In response to the recent increase of insurance fraud, insurance companies are enacting diverse efforts to protect innocent customers from insurance fraud and create a culture of honest insurance payments. One measure taken by insurance companies is to detect fraudulent insurance claims in a timely and appropriate manner and constructing an automated insurance fraud prevention system that provides objective and realistic decision-making while procuring insurance payout screeners with high capacities. SmartWorks FDS is a BRMS-based intelligent insurance fraud detecting system (FDS) that aims at objectively and realistically identifying insurance fraud behavior such as making fraudulent claims or exaggerating claims.

SmartWorks FDS is an IBM ILOG BRMS-based insurance payment screening system. SmartWorks FDS is comprised of a BRM framework for BRMS system construction and operation and a business model asset (KFRM: KSTEC FDS Reference Model) for drafting the business rules of the FDS system. The BRMS framework of SmartWorks FDS includes basic Java library needed for constructing ILOG BRMS and provides rule execution management modules and rule distribution management modules. KFRM Asset uses risk factors to judge insurance frauds and provides risk factor utilization models. SmartWorks FDS can create the following events for clients.

SmartWorks FDS is an IBM ILOG BRMS-based insurance payment screening system. SmartWorks FDS is comprised of a BRM framework for BRMS system construction and operation and a business model asset (KFRM: KSTEC FDS Reference Model) for drafting the business rules of the FDS system. The BRMS framework of SmartWorks FDS includes basic Java library needed for constructing ILOG BRMS and provides rule execution management modules and rule distribution management modules. KFRM Asset uses risk factors to judge insurance frauds and provides risk factor utilization models.

SmartWorks FDS can create the following events for clients.

• · Preemptive response to insurance payment risks for fraudulent claims
• · Use as underwriting index to prevent reverse selection of insurance
• · Quickly respond to new types of insurance frauds by constructing a BRMS-based quick and flexible work operation
  environment
• · Creates an honest payment culture and protects innocent customers to improve the company’s brand value