Claims Fraud Investigation
Investigates suspicious claims.
How it works
The workflow runs autonomously. Your team manages the exceptions and approves the decisions that matter.
1
Claim
2
links claimant/provider/event/network/history
3
scores fraud
4
collects evidence
5
creates investigation hypothesis
6
SIU reviews
7
disposition recorded
Runs autonomouslyYour team decides
Human control
- SIU reviews
Systems it works across
Business impact
Investigation cycle time drops sharply. Human attention concentrates on the cases that need judgment, and case quality becomes consistent.
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