About Us & Our Commitment to Ethical SIU investigation

About us

Claim Analysis Group exists to strengthen the fight against insurance fraud. We support insurers, TPAs, MGAs, and self-insured organizations that need structured investigative insight when claims present fraud indicators, inconsistencies, or unresolved questions

We’ve seen firsthand that questionable claims often slip through—not due to lack of expertise, but because adjusters and SIU teams face real constraints: limited time, bandwidth, and competing priorities.

Our role is to support that reality. We provide structured, independent SIU analysis that brings clarity to claims requiring closer review without disrupting workflows or requiring system access.

Our team is made up of experienced claim adjusters, SIU investigators, data analysts, and compliance professionals with over a decade of industry experience.

Fraud Indicator Claim Analysis

Travel Claim Fraud Indicator Review

Claim Background Insight Review

Our Approach

Insights

Case Studies

Remote Service Available Nationwide

Request a Case Review

Our Mission

Our mission is to strengthen the fight against insurance fraud by providing claims and SIU teams with independent investigative and analytical support that restores bandwidth, clarifies inconsistencies, and delivers defensible insight guided by human judgment, integrity, and confidentiality.

Our Differences

We do not replace internal teams, dictate outcomes, or access client systems. Our role is to bring structure, clarity, and documented analysis to claims that benefit from an additional layer of review.

Our work is intended to:

Caseloads limit your capacity for deeper review
Interpret Inconsistencies: We apply human judgement where automated tools flag patterns but cannot assess behavior.
Clarity without disruption: We enhance insight without changing your workflow.
Neutral: No advocacy for closure or escalation.
Defensible: Evidence-based investigations with clear documentation.
Ensure Thoroughness: We ensure no potentially significant details is overlooked simply because time is limited
No Integration: We work outside your systems no IT onboarding, no platform access, no credentials required.
Responsive: Inquiries answered within one business day; urgent reviews scheduled same day when possible.
Independent: We provide structured investigative insight only, no claim adjusting, coverage decisions, or PI services. All data comes from public, legally accessible sources.

Our Guiding Values

Clarity Over Assumption

Bring order to files through structured analysis and organized, reliable findings

Integrity First

Honesty, neutrality, and respect for the truth. Grounded in evidence

Every detail is handled with highest standard of discretion and security

We apply a balanced, human-led approach, critical thinking is key

Confidentiality

Human Judgement

Our work is guided by principles that emphaize integrity, disciplined analysis, and responsible judgement in every review we conduct

How We Work

No duplication of adjuster work: We complement, never replace the initial claim review
Fraud-focused methodology: Every service is built to uncover fraud exposure, inconsistencies, and indicators, not simply restate facts
Actionable intelligence: Our reports are structured for clarity, defensibility, and immediate use in carrier and SIU decision making
Human-led expertise, not automation

Our Review Process

Intake & Documentation Review
Pattern & Behavior Analysis
Independent finding Report
Optional Clarification Call

Turnaround Times

All reviews are conducted promptly while maintaining the analytical rigor required for defensible investigation insight.

Background Insight Review

24 hours - 48 Hours

3 Days - 5 days

Travel Claim Review

24 hours - 3 days

Fraud Indicator Analysis

Claim Defensibility Review

Most Claim Defensibility Reviews are completed within 3-5 business days, allowing sufficient time for fisciplined review of claim documentation, investigative steps, and decision rationale

Home

Tel: 713-487-7297

Email: contact@claimanalysisgroup.com

Address: 11811 North Freeway, Suite 222,

Houston, TX 77060