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This invention uses non-parametric statistical measures and probability mathematical techniques to calculate deviations of variable values, on both the high and low side of a data distribution, from the midpoint of the data distribution. It transforms the data values and then combines all of the individual variable values into a single scalar value that is a good-ness score. This good-ness behavior score model characterizes normal or typical behavior, rather than predicting fraudulent, abusive, or bad, behavior. The good score is a measure of how likely it is that the subjects behavior characteristics are from a population representing a good or normal provider, claim, beneficiary or healthcare merchant behavior. The good score can replace or compliment a score model that predicts bad behavior in order to reduce false positive rates. The optimal risk management prevention program should include both a good behavior score model and a bad behavior score model.


Patent
Risk Management Solutions Inc. | Date: 2013-11-04

A risk exposure model is developed for network or moveable assets not specific to a single, fixed address or location. An asset map using a plurality of geographic representation points is used to identify the physical locations of the asset portions (or possible physical locations in the case of a moveable asset). Baseline geographic, geologic, political, and demographic data is similarly represented using geographic representation points. Meta-data associated with each geographic representation point is used to identify details related to the asset or baseline feature at that geographic location. Risk exposure values are then calculated using the geographic representation points specific to the asset portions that are subject to risks associated with the location of the asset portion.


A system stochastically models events related to potential perils (e.g., hurricanes, terrorist attacks) using a weighted period event table. Both rare and likely events are captured in modeling with minimal computational overhead, allowing appropriate allocation of resources. Applications include disaster response, municipal planning, financial risk modeling and allocation.


Patent
Risk Management Solutions Inc. | Date: 2014-01-31

A system and method are provided for identifying exposure concentrations. The process of determining exposure concentrations may include organizing exposure data, defining parameters, determining elevated exposure concentrations, and providing output results. The exposure data may relate to at least geographical locations, policies, accounts, portfolios, treaties, and other exposure data. The parameters may be defined to include at least an area of analysis, a region of interest, a threshold amount, results parameters, and other parameters. The exposure concentration may include at least defining and locating exposure locations using various techniques. The results may be presented using textual, graphical, or other display schemes. The output may be configured to convey information such as positional accuracy of an identified area, exposure accumulation in a defined area, and other information.


The Automated Healthcare Risk Management System is a real-time Software as a Service application which interfaces and assists investigators, law enforcement and risk management analysts by focusing their efforts on the highest risk and highest value healthcare payments. The systems Risk Management design utilizes real-time Predictive Models, a Provider Cost Index, Edit Analytics, Strategy Management, a Managed Learning Environment, Contact Management, Forensic GUI, Case Management and Reporting System for individually targeting, identifying and preventing fraud, abuse, waste and errors prior to payment. The Automated Healthcare Risk Management System analyzes hundreds of millions of transactions and automatically takes actions such as declining or queuing a suspect payment. Claim payment risk is optimally prioritized through a Managed Learning environment, from high risk to low risk for efficient resolution by investigators.


A system stochastically models events related to potential perils (e.g., hurricanes, terrorist attacks) using a weighted period event table. Both rare and likely events are captured in modeling with minimal computational overhead, allowing appropriate allocation of resources. Applications include disaster response, municipal planning, financial risk modeling and allocation.


Patent
Risk Management Solutions Inc. | Date: 2016-04-12

A computing system and platform uses various types of data stores to allow efficient querying of, and accelerated access to, extremely large data sets. One such data store is a dimension store that combines key-value and columnar stores, access to which is provided by several selectable mechanisms chosen based the nature of the data of interest. These include bitmap-based access, us of an optimized columnar data format, and access via namespace identifiers. A compressed, optimized page data format is provided for storing and analyzing large fact-based data. The complex dimension store is used to provide complex relationships and interpretation of the fact-based data, enabling high-performance advanced queries, with bitmap indexes passed between the two stores. Dimension data is stored in an encrypted manner throughout the system, and can be exchanged among parties in a secure manner.


Patent
Risk Management Solutions Inc. | Date: 2013-12-30

A variable resolution grid provides a mechanism for focusing specific concentrations of risk exposure on a geographical grid to determine projected loss caused by a particular catastrophe. The geographic grid provides a stable base map by using latitudes and longitudes to define the grid points and cells. Each cell is assigned a geographic identifier or geocode that identifies the location of the cell and its associated resolution. The resolution of the grid may be varied depending in part, on the resolution of any available of hazard data.


Patent
Risk Management Solutions Inc. | Date: 2013-06-11

A system automatically processes rules for allocation of resources to mitigate damages resulting from a catastrophic event. Overlapping interests of various stakeholders are processed in a deterministic manner to ensure repeatable processing and modeling. In one embodiment the resources are disaster aid items; in another they are obligations regarding insurance.


Patent
Risk Management Solutions Inc. | Date: 2013-02-16

A system and method are provided for identifying exposure concentrations. The process of determining exposure concentrations may include organizing exposure data, defining parameters, determining elevated exposure concentrations, and providing output results. The exposure data may relate to at least geographical locations, policies, accounts, portfolios, treaties, and other exposure data. The parameters may be defined to include at least an area of analysis, a region of interest, a threshold amount, results parameters, and other parameters. The exposure concentration may include at least defining and locating exposure locations using various techniques. The results may be presented using textual, graphical, or other display schemes. The output may be configured to convey information such as positional accuracy of an identified area, exposure accumulation in a defined area, and other information.

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