{"title":"Auto insurance fraud detection: Machine learning and deep learning applications","authors":"Meryem Yankol-Schalck","doi":"10.1111/jori.70046","DOIUrl":null,"url":null,"abstract":"<p>Insurance fraud detection remains a challenging task due to severe data imbalance, evolving fraudulent behaviors, and the high false-negative rates exhibited by several state-of-the-art machine learning models. Traditional approaches often struggle to generalize real-world data and capture complex, non-linear feature interactions in insurance claims. This study aims to improve fraud detection performance by leveraging recent advances in deep learning. A comprehensive comparison between traditional machine learning models and deep learning techniques is performed on two distinct datasets using resampling strategies. The study proposes three convolutional neural network-based architectures to improve detection accuracy. Furthermore, a hybrid machine learning deep learning (ML-DL) framework is introduced to more effectively leverage discriminative features. Experimental results demonstrate that deep learning models would vary on each dataset due to the presence of variations in data characteristics, while the proposed hybrid ML–DL model achieves the best overall performance, highlighting its effectiveness in improving fraud prediction accuracy.</p>","PeriodicalId":51440,"journal":{"name":"Journal of Risk and Insurance","volume":"93 2","pages":"534-568"},"PeriodicalIF":1.9000,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Risk and Insurance","FirstCategoryId":"96","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jori.70046","RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/3/19 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"BUSINESS, FINANCE","Score":null,"Total":0}
引用次数: 0
Abstract
Insurance fraud detection remains a challenging task due to severe data imbalance, evolving fraudulent behaviors, and the high false-negative rates exhibited by several state-of-the-art machine learning models. Traditional approaches often struggle to generalize real-world data and capture complex, non-linear feature interactions in insurance claims. This study aims to improve fraud detection performance by leveraging recent advances in deep learning. A comprehensive comparison between traditional machine learning models and deep learning techniques is performed on two distinct datasets using resampling strategies. The study proposes three convolutional neural network-based architectures to improve detection accuracy. Furthermore, a hybrid machine learning deep learning (ML-DL) framework is introduced to more effectively leverage discriminative features. Experimental results demonstrate that deep learning models would vary on each dataset due to the presence of variations in data characteristics, while the proposed hybrid ML–DL model achieves the best overall performance, highlighting its effectiveness in improving fraud prediction accuracy.
期刊介绍:
The Journal of Risk and Insurance (JRI) is the premier outlet for theoretical and empirical research on the topics of insurance economics and risk management. Research in the JRI informs practice, policy-making, and regulation in insurance markets as well as corporate and household risk management. JRI is the flagship journal for the American Risk and Insurance Association, and is currently indexed by the American Economic Association’s Economic Literature Index, RePEc, the Social Sciences Citation Index, and others. Issues of the Journal of Risk and Insurance, from volume one to volume 82 (2015), are available online through JSTOR . Recent issues of JRI are available through Wiley Online Library. In addition to the research areas of traditional strength for the JRI, the editorial team highlights below specific areas for special focus in the near term, due to their current relevance for the field.