Fraud referral screening
Claims screened for fraud indicators before payment
How a run goes
The steps this agent takes, in order, and what each one leaves behind.
Reads the claim and the claimant's history
Screens each claim against the fraud indicators: timing, prior claims, provider patterns and inconsistencies in the statements
Applies the indicators and scores the claim
Drafts the referral to the special investigations unit with the indicators and the evidence
Drafts the referral and logs the outcome
Reports referrals and outcomes by indicator so the screening improves
Works in
Snowflake, Box, ServiceNow
Snowflake, Box, ServiceNowWhat it does
- Screens each claim against the fraud indicators: timing, prior claims, provider patterns and inconsistencies in the statements
- Drafts the referral to the special investigations unit with the indicators and the evidence
- Reports referrals and outcomes by indicator so the screening improves
Connects to
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