In anticipation of his upcoming conference presentation, Claim Pattern Anomalies – Making a Mole Hill Out of a Mountain at Predictive Analytics World San Francisco, May 14-18, 2017, we asked Darryl Humphrey, Senior Data Scientists at Alberta Blue Cross, a few questions about his work in predictive analytics. Q: In your work with predictive analytics, what behavior or outcome do your models predict? A: Our scope is health, dental, and pharmacy benefit claims submitted by plan members and providers. Our objective is to reliably gauge the probability that a claim, or series of claims, is / are fraudulent or represent abuse of
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