Using AI-powered machine learning models to identify fraudulent unemployment claims

With unemployment application submissions reaching record numbers over the past year, state and local agencies in the United States have faced the challenge of processing unprecedented numbers of claims per week. The digital infrastructure most agencies have in place is unable to handle this volume, resulting in constituents waiting longer, and bad actors taking advantage of vulnerable systems. The Department of Labor Inspector General estimates that $63 billion in claims distributed is either an improper payment or fraud. 

Validating claims also requires secure data sharing with other agencies for document and identity verification. Government leaders need a way to allow case adjudicators to quickly and confidently release backlogged claims, integrate with existing systems, and segment legitimate claims from potentially fraudulent ones -- all within limited government budgets -- securely and at scale.

Implementing a fraud detection solution on Google Cloud

States were under pressure to release payments, while also filtering out potentially fraudulent claims. SpringML and Google Cloud developed a framework to give adjudicators a reliable verification process that quickly filters potentially fraudulent claims, while processing the remaining claims so benefits reach citizens in a timely manner. SpringML and Google Cloud, applied AI-powered machine learning models to detect anomalous patterns in large datasets. Using Google Cloud tools, SpringML implemented a solution to streamline workflows, improve efficiencies, automate processes and identify potentially fraudulent claims.

SpringML used a variety of Google Cloud products to deliver a fraud detection solution, including:

• Google Cloud Storage to store and manage data
• BigQuery to store tabular data and BigQuery Machine Learning (BQML) to conduct machine learning on that data
• AutoML solutions to build predictive models and risk scoring
• Visualization tools such as Looker and Data Studio to present data and help government leaders make informed decisions.

Implementing machine learning to detect improper payments allows agencies to classify claims as “fraud” or “not fraud” based on the number of flags, as well as prioritize the most urgent claims. Deploying intelligent virtual agents to handle frequently asked questions meant that live agents could focus their time on more challenging cases. 

Even once the pandemic is behind us, there will be bad actors trying to take advantage of overwhelmed or legacy systems. We’ve identified a few best practices for agencies managing enormous case loads and looking to improve improper payment analytics: 

• Move your systems to the cloud. Many on-premises legacy systems can’t update their applications and scale to meet the volume of claims. Moving to a cloud environment enables rapid solution deployment and ingestion of large amounts of data without fear of overloading the system. The cloud scales with you--cost-effectively and securely. 
• Understand patterns in the data. The answer is always in the data -- we used deep analysis to help uncover suspicious patterns in large data sets. We implemented unsupervised machine learning to learn behaviors and create configurable rules that adjust to new information that comes into the system. We can uncover patterns that are likely associated with fraud - ones that a human might have missed. 
• Use AI/ML tools to automate your existing systems and teams. These tools enable humans to work smarter and more efficiently. We automate anomaly detection and create dashboards for adjudicators to rapidly process claims. We are enabling the Wisconsin Department of Workforce Development by implementing automatic calculations and processing of recharge amounts, resulting in faster processing times and fewer human errors. Proactive fraud detection and timely calculation of recharge payment allowed DWD to ensure the benefits reached the right individuals.
• Build flexibility into your systems. We discovered that fraud patterns change over time. For instance,flags for fraud during March-May 2020 were vastly different from those we found in June-July 2020. Google Cloud tools make it easy to continually update algorithms to detect patterns and integrate external data sources.

Using Google Cloud tools, we can update digital infrastructure and incorporate machine learning best practices to help organizations efficiently process large volumes of claims and identify high probability fraudulent ones. SpringML provides consulting and implementation services and industry-specific analytics solutions that deliver high-impact business value to accelerate data-driven digital transformation. Learn more about fraud detection and how to improve improper payments analytics by watching our webinar.