Frequently Asked Questions

What does Claim Analysis Group do?

Claim Analysis Group provides independent investigative analysis for insurance claims that present ambiguity, complexity, or potential fraud exposure. Our work helps carriers strengthen claim defensibility through structured analytical reviews.

Who hires Claim Analysis Group?

Our services are intended for insurance carriers, TPAs, MGAs, self-insured organizations, and SIU departments seeking additional investigative analytical support.

Does Claim Analysis Group adjust claims?

No.

We do not perform claim adjusting, determine coverage, negotiate settlements, or issue claim decisions. Those responsibilities remain entirely with the carrier.

Does Claim Analysis Group replace SIU?

No.

We are designed to complement existing SIU and claims teams by providing additional investigative analysis when internal resources are limited or when a file would benefit from an independent review.

What types of claims do you review?

Our work commonly includes:

Travel claims
Medical reimbursement claims
Trip cancellation claims
Verification reviews
Document authenticity concerns
Fraud indicator reviews
Background intelligence reviews
Complex claim defensibility reviews

What information do you need?

We review only the information provided by the carrier.
We do not require direct access to internal claim systems.

Do you access our claim software?

No.
Our work is performed entirely outside carrier systems.
No software installation.
No IT integration.
No workflow disruption.

How long does a review take?

Turnaround depends on complexity. Many reviews are completed within one to five business days.

Do you contact claimants?

Generally, no.

Our methodology focuses on analytical review using carrier-provided materials, public information, OSINT research, and metadata analysis.

If additional verification appears appropriate, we provide recommendations to the carrier.

Do you contact medical providers?

No.

Provider verification remains the responsibility of the carrier or other authorized parties.

Can you review only part of a file?

Yes.

Many clients request targeted reviews of specific documents, timelines, receipts, invoices, or medical records.

Is our information confidential?

Yes.

Confidentiality is fundamental to our work.

Information is handled solely for the purpose of completing the requested analytical review.

What systems or software does Claim Analysis Group use?

Claim Analysis Group does not require access to your internal claim management systems or proprietary software. Our analytical reviews are conducted independently using the information provided by the carrier, together with publicly available information, open-source intelligence (OSINT), metadata analysis, and other investigative research methods appropriate to the assignment.

This independent approach allows us to integrate seamlessly into existing claims operations without software installation, IT integration, or disruption to your established workflows.

Do you use artificial intelligence (AI) to investigate claims?

Claim Analysis Group uses technology to support research and improve efficiency where appropriate, but every assignment is reviewed and analyzed by an experienced human investigator.

We believe investigative conclusions should be based on professional judgment, documented evidence, and objective analysis. Technology can assist the process, but it does not replace human reasoning or independent evaluation.

Technology is a tool, not a substitute for judgment.

Claim Analysis Group uses technology where it improves efficiency and supports research. Every assignment, however, is ultimately evaluated by an experienced investigator who is responsible for the analysis, findings, and conclusions. We believe technology should strengthen professional judgment, not replace it.