Embedded information
Claims Escalation & Fraud Referral Process
The step-by-step process for escalating suspicious claims to the Special Investigations Unit.
Information Advantage assessment
Information Advantage Score
57 / 100
Confidence: not yet assessed -- add evidence below
| Factor | Score | Weight | Contribution |
|---|---|---|---|
| Uniqueness | 4 / 5 | 20% | 0.80 |
| Quality | 3 / 5 | 12% | 0.36 |
| Depth | 4 / 5 | 8% | 0.32 |
| Freshness | 3 / 5 | 6% | 0.18 |
| Connectivity | 2 / 5 | 10% | 0.20 |
| Actionability | 2 / 5 | 14% | 0.28 |
| Economic Value | 2 / 5 | 18% | 0.36 |
| AI Readiness | 3 / 5 | 12% | 0.36 |
Seeded assessment for the demonstration dataset.
Assessed 8/29/2026
Information Leverage
How much organisational impact this asset could influence -- a separate measure from Information Advantage above, never combined with it. Computed from the decisions and frictions this asset is actually linked to below, not asked for directly.
Low (20/100)
- decisionReach: band 1/5 × weight 0.25 = 0.25
- decisionFrequency: band 1/5 × weight 0.25 = 0.25
- decisionImportance: band 1/5 × weight 0.25 = 0.25
- workflowReach: band 1/5 × weight 0.15 = 0.15
- peopleAffected: band 1/5 × weight 0.1 = 0.10
Not incorporated: "decision importance" and "economic consequence" are collapsed into one proxy (decisionCostEstimate) -- no field distinguishes them; "people affected" is only ever populated from linked Frictions, not from any Decision-level field, since none exists.
Evidence
What backs the score above, factor by factor. Recalculated into the Confidence figure the next time this asset is re-assessed.
No evidence recorded yet -- this is currently an opinion, not yet backed by anything checkable.
AI Opportunities
No opportunities generated from this asset yet.
CLEAN status
CLEAN status
- Capture→ Identified information asset
- ✓
- Label→ Contextualised asset
- ✓
- Evaluate→ Quality/value/uniqueness assessment
- ⚠
- Align→ Business decision/use-case alignment
- ⚠
- Nurture→ Continuous improvement and monitoring
- –
Next: Formally evaluate uniqueness and value, then align to an AI opportunity.
Assessed 8/29/2026
Friction & Diagnosis
Where this asset shows up as the information behind a friction, or in a diagnosis of one.
Not linked to any friction or diagnosis yet.
Ownership & source
- Department
- Claims
- Source system
- —
- Owner
- Head of Claims
- Business process
- Fraud referral and investigation
- Format
- Process documentation + practice
Volume & freshness
- Approximate volume
- 1 core process, ~15 trigger criteria
- Historical depth
- Refined over 10 years
- Update frequency
- Quarterly
Governance
- Accessibility
- Restricted
- Data quality
- Fair
- Sensitivity
- Confidential
- Regulatory considerations
- —
Value & usage
- Existing usage
- Claims handler triage.
- Current business value
- Directly reduces fraud leakage.
- Potential future value
- Formalising trigger criteria enables automated fraud-risk flagging at first notification of loss.
Competitive position
- Competitor accessibility
- Difficult
- Could a competitor reproduce this?
- No
- Additional tacit knowledge held by employees?
- Yes
- Tacit knowledge notes
- Experienced handlers apply extra, unwritten triggers based on 'gut feel' pattern recognition.