Claims fraud referral preparation
Investigators need related claim and policy evidence without treating suspicious patterns as proof.
The challenge behind the workflow.
Investigators need related claim and policy evidence without treating suspicious patterns as proof.
Bring exposure, policy, claims, repair, and financial data into a common working context. Help underwriters, claims teams, and catastrophe analysts investigate exceptions without losing the history behind a decision.
Data to bring together
- Claim histories
- Policy relationships
- Authorized external references
Source systems are examples of the data required. Confirm connector availability, permitted access, refresh timing, and the authoritative owner before implementation.
How Genedata supports the work.
Configure one connected workflow, then reuse its mappings, definitions, and review process as the business grows.
- 01
Connect and prepare
Connect permitted records and document relationship confidence and source limitations.
Build the preparation as a reusable visual workflow or reviewed code, with explicit source mappings and validation checks. - 02
Investigate and validate
Identify repeated attributes or inconsistent narratives for specialist assessment.
Keep shared definitions and source versions with the analysis so another team can reproduce the result. - 03
Publish and review
Deliver an evidence pack with investigation questions and traceable references.
Make the output available to the right people with appropriate access, ownership, and review evidence.
A fraud investigation evidence pack
Make the next run easier.
Reusable relationship views reduce manual assembly of potentially related cases.
Start from one approved example. Save the agreed mappings and definitions, publish the reviewed output, and let the next team follow the same evidence instead of rebuilding the preparation.
Measure your own improvement
Investigator preparation time
Record a baseline before the pilot and compare like-for-like work afterward. Results depend on source quality, configuration, and adoption.Review and responsibility
Human investigators assess referrals; indicators do not establish fraud.
AI with professional judgment.
Use AI to summarize documents and suggest investigation questions. Coverage, pricing, fraud referrals, and claim payments require authorized review.
Try the workflow with your team.
Use representative, approved sample data. Agree the expected output and a review owner before extending the workflow to a live process.