This service supports SIU and claims teams by:

• Reviewing available claim materials

• Identifying investigative considerations and risk signals

• Documenting observations, gaps, and contextual factors

• Delivering clear, neutral analytical summaries

Remote Service Available Nationwide

Use Cases

Questionable losses, conflicting narratives, suspicious documentation, and claims requiring structured analytical review.

• Questionable losses or inconsistent claim narratives
• Suspicious injury or treatment patterns
• Conflicting statements or timeline discrepancies
• Potential staged loss indicators
• Questionable or altered documentation
• Travel claims presenting soft fraud indicators

Why Use CAG for Fraud Indicator Claim Review?

SIU teams are designed to handle high-risk claims, but even experienced units face capacity limits. Deep-dive investigations require uninterrupted time, cross-file comparison, and detailed documentation all while new referrals continue to arrive.

Claim Analysis Group supports SIU teams when a claim needs deeper analytical attention than internal bandwidth allows. We step in to review complex files, compare patterns across claims, and document findings in a structured, defensible format that supports SIU decision-making.

This allows SIU teams to:

• obtain deeper analysis on specific files without delaying others

• strengthen documentation for coverage, litigation, or regulatory review

• escalate, defend, or resolve claims with greater confidence

• focus internal resources on the highest-priority referrals