Assess whether a provider should be suspended pending SIU (78b46f)

Situation

A provider should be sits with bank BSA/AML case manager because a 400% utilization jump in 11 days hit a P&C carrier's auto-body network. Evidence is bust-out credit-line utilization curve; write the Fraud Detection Claims and Benefits Fraud option that extract can carry.

Decision

Bank BSA/AML case manager in a P&C carrier's auto-body network must choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold using bust-out credit-line utilization curve after a 400% utilization jump in 11 days.

Hypotheses to test

• Bank BSA/AML case manager can defend Remove access or reverse the item from bust-out credit-line utilization curve after a 400% utilization jump in 11 days in a Fraud Detection challenge.
• Bank BSA/AML case manager cannot defend Remove access or reverse the item from bust-out credit-line utilization curve; Temporary compensating control is what the extract actually supports after a 400% utilization jump in 11 days.
• A 400% utilization jump in 11 days never reached the population in bust-out credit-line utilization curve — reopen intake, do not close a provider should be.
• Two facts in bust-out credit-line utilization curve after a 400% utilization jump in 11 days conflict for bank BSA/AML case manager; hold this Claims and Benefits Fraud file.

Analysis required

• Map typology and hold authority bank BSA/AML case manager actually has in a P&C carrier's auto-body network.
• Trace funds, counterparties, and reversals in bust-out credit-line utilization curve through the window opened by a 400% utilization jump in 11 days.
• Quantify loss if the hold is released before bust-out credit-line utilization curve is complete.
• For this Fraud Detection Claims and Benefits Fraud file, read bust-out credit-line utilization curve against a 400% utilization jump in 11 days and write the one fact that would move a provider should be for bank BSA/AML case manager.

Recommendation

Choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold on this Fraud Detection / Claims and Benefits Fraud packet (bust-out credit-line utilization curve after a 400% utilization jump in 11 days). Lead with the Fraud Detection option bust-out credit-line utilization curve can support after a 400% utilization jump in 11 days, then the two facts that force it, then the Monday action for bank BSA/AML case manager in a P&C carrier's auto-body network.