Claims leakage investigation
Finance and claims teams need to distinguish processing errors from legitimate differences in claim handling.
The challenge behind the workflow.
Finance and claims teams need to distinguish processing errors from legitimate differences in claim handling.
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
- Payment transactions
- Coverage records
- Claim approval histories
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
Link payments to coverage and approval evidence using consistent claim identifiers.
Build the preparation as a reusable visual workflow or reviewed code, with explicit source mappings and validation checks. - 02
Investigate and validate
Flag duplicate candidates, unexplained adjustments, and missing approval references.
Keep shared definitions and source versions with the analysis so another team can reproduce the result. - 03
Publish and review
Deliver an exception analysis with case context and assigned follow-up.
Make the output available to the right people with appropriate access, ownership, and review evidence.
A claims payment-control review
Make the next run easier.
Shared exception rules replace separate spreadsheet checks across claims teams.
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
Time resolving payment-control exceptions
Record a baseline before the pilot and compare like-for-like work afterward. Results depend on source quality, configuration, and adoption.Review and responsibility
Claims owners validate exceptions before recovering funds or changing customer outcomes.
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.