Fraud Detection & SIU Investigation Analytics

Guardrail Insurance • Personal Auto & Workers Comp • 89K Claims/Month

SIU Referral Rate
8.2
per 1,000 Claims
+0.4
Confirmed Fraud Rate
14.0%
of Referrals
+1.2%
Model Precision
71%
Fraud Score Accuracy
-3%
Avg Days to Closure
38
SIU Investigation
-5 days
Fraud Recovery
$4.2M
Last 90 Days
+18%
False Positive Rate
41%
Target: 28%
+2%

Fraud Savings vs Incurred Losses (90-Day Rolling)

Referral Outcome Funnel

Investigation Velocity by Claim Type

Active SIU Investigations (Top 10 by Potential Recovery)

Claim ID Type Fraud Score Red Flags Potential Recovery Days Open Investigator Status
CLM-9834712 Auto - Staged 94 Network Link $284,500 22 J. Rivera Field Inv
CLM-9834689 WC - Provider 88 Repeat Provider $192,300 41 M. Chen Legal Review
CLM-9834621 Auto - Injury 91 Att. Pattern $167,800 18 D. Park Field Inv
CLM-9834573 Auto - Staged 96 Network Link $156,200 9 J. Rivera Evidence Collect
CLM-9834502 WC - Disability 85 Surveillance $143,700 56 A. Santos Legal Review
CLM-9834448 Auto - Property 79 Prior Claim $128,900 33 M. Chen Field Inv
CLM-9834391 Auto - Injury 92 Att. Pattern $119,400 14 D. Park Evidence Collect
CLM-9834312 WC - Provider 87 Repeat Provider $107,600 27 J. Rivera Field Inv

Provider Repeat Flag Rate

Attorney Network Clusters

Martinez & Associates
Miami-Dade Network
34
Linked Claims
Chen Law Group
Broward County
19
Linked Claims
Parker Injury Firm
Orange County
12
Linked Claims
Rodriguez Legal
Hillsborough County
8
Linked Claims

False Positive Trend

Target: 28% by Q3

Model Recall (Sensitivity)

Catching 82% of true fraud

Fraud Savings per SIU FTE

$427K per investigator (90d)

High-Confidence Fraud Alerts (Score ≥85)

Staged Accident Cluster Detection

Miami-Dade Ring
34 Claims
$2.8M Potential Recovery
Martinez & Associates network • 9 shared addresses • 12 common witnesses
Broward County
19 Claims
$1.4M Potential Recovery
Chen Law Group • 6 overlapping providers
Orange County
12 Claims
$890K Potential Recovery
Parker Firm • Telematics anomalies
Model Version: FRISS v4.2.1 (Deployed: Jan 15, 2025) • ISO ClaimSearch: Real-time integration enabled • Last Updated: 2 hours ago
North Star: 2.1% Fraud Savings (Target: 2.8%)