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Suspicious Activity Report

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Details

Evaluates claim behavior to determine when a Suspicious Activity Report may be required and facilitates the reporting process.

Description

List of scenarios that may require suspicious activity reporting, based on the following criteria:

  1. Claim Reason Type is "Fraud" AND
  2. Sum of Dispute Amount > $25k OR
  3. (Sum of Dispute Amount > $5k AND Suspect Count > 0) AND
  4. Not already associated with a SAR case

Category

Risk

Report KeySUSPICIOUSACTIVITYSAR
Report TypeList
Fields

Customer Name, Number of Claims, Total Dispute Amount, Total Suspect Count

Filter Parameters

Claim Type, Claim Category, Contact Date, Account Type

Sample

Summary

Drill Down

Click on any row in the report to see the claim activity for that particular customer.




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