Signals & Rules
Red flags for policy/claim, identity/device, provider behaviour, and document anomalies.
Detect and stop fraud across underwriting and claims: rules & ML models, link analysis & networks, image/video forensics, provider/partner scoring, alerts & queues, investigations & evidence, recoveries & reporting — integrated with PAS/Claims and provider networks.
Red flags for policy/claim, identity/device, provider behaviour, and document anomalies.
Supervised/unsupervised models, anomaly detection, and outlier scoring.
Entities graph (customers, devices, addresses, providers) with risk propagation.
EXIF/tamper checks, similarity search, and staged‑photo detection hooks.
Hospital/garage risk, over‑billing, coding anomalies, and kickback red flags.
Scored alerts with SLAs, prioritised work queues, and escalation paths.
Assignments, interviews, site visits, evidence vault, and legal handover.
Recovery tracking, write‑back to claims, penalties, and learning loop.
Hit‑rate, precision/recall, TAT, savings, and provider heatmaps.
Consent, access controls, and privacy‑by‑design for sensitive data.
Case logs, outcomes, and periodic compliance packs.
PAS/Claims, provider networks, payment gateway, OCR, and BI tools.