UC-389
Claims Fraud Network & Staged-Loss Rings
Links claimants, repairers, medical experts and addresses across claims, scores the networks and surfaces organised rings for investigation.
TBDBuild Duration
XXXXIndicative ROI
XXXXBuild Cost
XXXXValue
The Challenge
Organised fraud is found one claim at a time, long after the repair invoice is paid. Each claim is assessed on its own file, so the shared garage, phone number or witness never becomes visible.
How It Works
- Reads claim files, repair invoices, medical reports, payment records and fraud referrals.
- Links shared parties, addresses, devices and bank details into networks and scores each one.
- Hands the counter-fraud team a ranked ring with its member claims and the link that binds them.
What It Removes
- Case-by-case fraud review with no cross-claim view
- Manual searching for repeat garages and witnesses
- Referring clean claims to investigation on a hunch
Input Data RequirementsClaim files and notes, repair and hire invoices, medical reports, payment and bank records, policy and quote history, counter-fraud referral logs
Output FormatRanked register of suspected fraud networks with member claims, exposure at risk and the shared attributes that formed the link
“The same garage was on forty of our claims and nobody saw it, because nobody was looking across claims.”