عباس راد
"Fraud Detection in Healthcare Insurance Based on Smart Contract in Blockchain Network"
- رشته تحصیلی
- بيمه
- مقطع تحصیلی
- دکتری تخصصی PhD
- تاریخ دفاع
- ۲۸ شهریور ۱۴۰۳
- ساعت دفاع
- چکیده
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In this research, we discovered a new innovative way to detect fraud in the healthcare insurance industry while also proposing blockchain-based core insurance software to reduce claim processing time and increase the system's overall efficiency by introducing standardized processes. To fulfill the research objective, the present research considers the literature on fraud in healthcare insurance, blockchain, and smart contracts to find the best platform and consensus mechanism. Blockchain is applied to store data and smart contracts are used to automate insurance policies.
Furthermore, a web-based application (web app), which acts as core insurance software, is proposed for all stakeholders to communicate with the blockchain and smart contracts. These smart contracts will be deployed on the blockchain, which means interactions with the policy are automatically run by blockchain node. Consequently, digital insurance policies assist in reducing human errors and increasing processing time by automating Insurance processes. Anchored by a private blockchain with the robust Proof of Authorized Work (PoAW) consensus algorithm, this thesis showcases the potential of Digital Insurance Policies (DIPs) and Digital Insurance Claims (DICs) with their profound role in revolutionizing policy management, endorsements, renewals, and claim processing. Application models greatly assisted in bringing fraud detection using digital signatures to life. We explored real-life healthcare scenarios where the system detects fraudulent actions through signatures, public keys, and blockchain mechanisms, which revealed the tangible impact on insurance processes.
The scheme uses a quantitative research method to experiment with the proposed system through software models and applications. Eventually, the best techniques to put the system to the test and evaluate the findings are assessed. In the next stage, different methods to simulate the proposed system are utilized to choose the finest option for this thesis. We later briefly dissected the cost evaluations of the proposed system, ranging from design to hardware expenses. The benefits and limitations of the proposedsystem are weighed in detail.
- Abstract
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In this research, we discovered a new innovative way to detect fraud in the healthcare insurance industry while also proposing blockchain-based core insurance software to reduce claim processing time and increase the system's overall efficiency by introducing standardized processes. To fulfill the research objective, the present research considers the literature on fraud in healthcare insurance, blockchain, and smart contracts to find the best platform and consensus mechanism. Blockchain is applied to store data and smart contracts are used to automate insurance policies.
Furthermore, a web-based application (web app), which acts as core insurance software, is proposed for all stakeholders to communicate with the blockchain and smart contracts. These smart contracts will be deployed on the blockchain, which means interactions with the policy are automatically run by blockchain node. Consequently, digital insurance policies assist in reducing human errors and increasing processing time by automating Insurance processes. Anchored by a private blockchain with the robust Proof of Authorized Work (PoAW) consensus algorithm, this thesis showcases the potential of Digital Insurance Policies (DIPs) and Digital Insurance Claims (DICs) with their profound role in revolutionizing policy management, endorsements, renewals, and claim processing. Application models greatly assisted in bringing fraud detection using digital signatures to life. We explored real-life healthcare scenarios where the system detects fraudulent actions through signatures, public keys, and blockchain mechanisms, which revealed the tangible impact on insurance processes.
The scheme uses a quantitative research method to experiment with the proposed system through software models and applications. Eventually, the best techniques to put the system to the test and evaluate the findings are assessed. In the next stage, different methods to simulate the proposed system are utilized to choose the finest option for this thesis. We later briefly dissected the cost evaluations of the proposed system, ranging from design to hardware expenses. The benefits and limitations of the proposedsystem are weighed in detail.