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Edit Veteran Claims Assessors' Fraud Pattern Intuition
Basic information
Asset name
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Description
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Pattern recognition experienced assessors use to sense a claim is suspicious before any formal indicator fires.
Information category
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Explicit
Embedded
Tacit
Derived
Business process
Ownership & source
Department
— none —
Actuarial & Risk
Claims
Compliance & Regulatory
Customer Service
Finance
Human Resources
IT & Data
Marketing
Sales & Distribution
Underwriting
Source system
— none —
Actuarial Modelling Platform
CRM (Salesforce)
Claims Management System
Contact Centre Platform
Document Management System
Enterprise Data Warehouse
Finance ERP
HRIS (Workday)
Policy Administration System
Underwriting Rules Engine
Owner
Data / document format
Volume & freshness
Approximate volume
Historical depth
Update frequency
— none —
Realtime
Daily
Weekly
Monthly
Quarterly
Annually
Ad Hoc
Static
Governance
Accessibility
— none —
Open
Internal
Restricted
Confidential
Data quality
— none —
Poor
Fair
Good
Excellent
Sensitivity
— none —
Public
Internal
Confidential
Restricted
Regulatory considerations
Value & usage
Existing usage
Informal, inconsistent across the team.
Current business value
Meaningfully reduces fraud leakage where these assessors handle claims.
Potential future value
Interviewing and codifying this into features could lift fraud detection consistency across the whole team.
Competitive position
Competitor accessibility
— none —
Easy
Moderate
Difficult
Near Impossible
Could a competitor reproduce this?
— unknown —
Yes
No
Employees hold additional tacit knowledge around this asset
Tacit knowledge notes
Never formally interviewed or documented — this asset IS the tacit knowledge itself.
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