Policy Fraud Case Management
Insurance policies can exhibit various suspicious behaviours, including unusual claim patterns, suspected commercial use, and potential fronting or ghost broking. Our policy fraud case management module provides users with everything they need to investigate risky policies effectively.
$
40
M
Cost avoidance through intervention
↑
500
Manage up to 500 policies per investigation
Policy Fraud Case Management: Investigate risky policies effectively
For any investigation, it’s crucial that the right person handles the case. Our intuitive interface allows team leaders to allocate cases to the most suitable investigators. Since our system can identify all entities related to an initial policy, sometimes spanning hundreds of other policies with risky characteristics, our queue-based allocation module helps your team manage their workflow efficiently.
Essential compliance
Once a case is allocated, our policy case management system provides investigators with all the tools they need for a successful investigation. This includes clear, comprehensive information about policies and their related claims, activity logs, external contact administration, and the ability to identify and refer entities of interest. Everything is configurable, allowing you to create investigation policies, manage teams, and set up operations according to your business requirements.
Procedural compliance is essential for justifying decisions to terminate a policy or decline future coverage. Our application is fully audited, recording every step of an investigation to ensure complete transparency and accountability.
Like all our applications, our case management modules can be deployed independently or as an integrated part of our broader solution, providing flexibility and scalability to meet your needs.
Key Benefits
Efficient Case Allocation
Assign cases to the right investigators using our intuitive interface and queue-based allocation module.
Comprehensive Tools
Access clear information about policies and claims, activity logs, external contacts, and entities of interest in one place.
Configurable System
Tailor investigation policies, team management, and operations to meet your specific business requirements.
Complete Audit Trail
Ensure procedural compliance with a fully audited system that records every step of the investigation.
Our Investigate services
Built with compliance and auditability in mind, our Investigate suite helps reduce investigation time, improve resolution rates, and support better outcomes across the fraud lifecycle.
FAQs
How structured case management supports effective policy fraud investigations.
How is policy fraud case management different from claims case management?
Policy fraud cases often happen earlier in the lifecycle and involve underwriting context, application evidence and premium leakage impacts. The workflow supports policy-specific evidence, decisions and outcomes.
Can we manage pre-bind and post-bind investigations?
Yes. You can run different workflows depending on whether you’re reviewing a quote/application, a mid-term adjustment, or a pattern across an in-force book.
Can we document decisions for fairness and customer outcomes?
Yes. Cases can capture reason codes, evidence, actions taken and customer communications so decisions are transparent and defensible.
How do we handle high-volume, low-value policy abuse efficiently?
You can triage with thresholds and automation, apply step-up checks for medium risk, and reserve full investigations for higher materiality or organised signals.
Can we collaborate with underwriting and pricing teams?
Yes. Role-based access and workflow steps can involve underwriting, pricing and fraud teams while keeping a single source of truth.
What metrics matter most for policy fraud case management?
Common measures include time-to-decision, leakage prevented, quality of referrals, downstream claims reduction, and customer impact (e.g., complaint rate).
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