Frequently Asked Questions

What does Claim Analysis Group do?

Claim Analysis Group provides independent, human-led investigative analysis for insurance claims requiring deeper examination.

We help claims and SIU teams verify material facts, evaluate evidence in context, clarify inconsistencies, and understand what the available evidence supports through structured analysis and clear investigative reporting.

Who hires Claim Analysis Group?

Our services are designed for insurance carriers, TPAs, MGAs, self-insured organizations, claims teams, and SIU departments seeking additional investigative and analytical capacity.

Does Claim Analysis Group adjust claims?

No.

CAG does not determine coverage, establish claim value, negotiate settlements, authorize payments, or make claim disposition decisions. Claim and coverage authority remains with the client.

Does Claim Analysis Group replace SIU?

No.

CAG complements existing SIU and claims teams by providing additional investigative capacity and independent analytical perspective when a file requires deeper examination.

We work alongside not in place of, existing claims professionals, SIU resources, investigative vendors, and technologies.

What types of claims do you review?

CAG's services include:

• Fraud Indicator Analysis

• Travel Claim Analysis

• Claim Defensibility Analysis

Assignments may involve questionable documentation, unresolved material facts, conflicting information, timeline inconsistencies, international verification challenges, suspected fraud, or files requiring additional analytical rigor.

Targeted reviews of specific documents, transactions, timelines, or other components of a claim may also be performed.

What information do you need?

The information required depends on the scope of the assignment.

Clients generally provide the relevant claim documentation, investigative materials, and specific concerns or questions requiring examination.

CAG may supplement those materials through appropriate public sources, open-source intelligence, metadata, independent research, and factual verification within the agreed scope of the assignment.

CAG does not require direct access to internal claim systems.

Do you access our claim software?

No.

CAG operates independently of client claim systems. No software installation, system implementation, or IT integration is required.

This allows CAG to provide additional investigative capacity without disrupting established claims workflows.

How long does a review take?

Turnaround depends on the scope and complexity of the assignment.

Many reviews are completed within one to five business days. More complex matters or assignments requiring additional verification may require additional time.

Do you contact claimants?

No.

CAG does not contact claimants.

Our work focuses on independent analysis and factual verification using client-provided materials and appropriate investigative sources and methods. When reasonably necessary and within the authorized scope of an assignment, CAG may conduct factual verification with appropriate third-party sources.

CAG does not negotiate with claimants, determine coverage, establish claim value, or make claim disposition decisions.

Do you contact medical providers or other third parties?

When reasonably necessary and appropriate to the assignment, CAG may conduct limited factual verification with appropriate third-party sources, subject to client authorization, applicable requirements, and the defined scope of the engagement.

The purpose of such contact is to corroborate material information not to adjust the claim, discuss coverage, negotiate, or make claim decisions.

Can you review only part of a file?

Yes.

CAG can conduct targeted analysis of specific documents, timelines, receipts, invoices, medical documentation, verification questions, or other defined components of a claim when a full-file review is unnecessary.

Is our information confidential?

Yes.

Confidentiality is fundamental to CAG's work. Client and claim information is handled solely for authorized purposes associated with the engagement and in accordance with applicable agreements and information-handling requirements.

What systems or investigative resources does CAG use?

CAG selects investigative resources according to the needs of the assignment.

These may include client-provided information, publicly available information, open-source intelligence (OSINT), metadata, independent records and research, and other appropriate investigative resources.

CAG does not require access to the client's internal claim management system or implementation of proprietary CAG software.

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

Technology may be used to support research, organization, and analytical efficiency where appropriate, but technology does not independently determine CAG's investigative conclusions.

Every assignment remains human-led. CAG analysts are responsible for evaluating the evidence in context, assessing the significance of findings, challenging unsupported assumptions, and ensuring conclusions remain grounded in the available evidence.

Technology can strengthen the investigation. Human judgment governs the analysis.

Do you store claim files?

Claim information is retained only as necessary to perform the engagement and in accordance with applicable retention requirements, contractual obligations, and client agreements.

What does your final report include?

The contents depend on the scope of the assignment and may include:

• Established and verified facts

• Timeline analysis

• Document observations

• Metadata findings

• Public-source intelligence

• Verification findings

• Identified inconsistencies or unresolved questions

• Analytical observations

• Investigative recommendations

• Supporting exhibits

Can your reports support litigation or regulatory review?

CAG reports are structured to clearly document the information reviewed, verification performed, material findings, analytical observations, and unresolved questions.

This disciplined approach can assist clients in maintaining well-documented and defensible claim files for internal review, regulatory scrutiny, or potential litigation.

CAG does not provide legal opinions, and the use of CAG's findings in legal or regulatory matters remains subject to the client's counsel and applicable requirements.