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?