Back to casesInsurance
Advanced30 minAnomaly ScoringFraud Ring DetectionCost-Benefit

Auto Claims Fraud Prioritization for SIU Investigation Queue

Ridgeline Mutual Insurance is a mid-size personal auto insurer operating across the southeastern United States. Their Special Investigations Unit (SIU) manually reviews claims flagged for potential fraud, but has limited investigator capacity.

SIU leadership has noticed that their current fraud referral process sends too many claims to investigators, most of which turn out to be legitimate.

The business question

How should we prioritize fraud investigations to maximize recovered dollars?