Assess whether a provider should be suspended pending SIU (b36c2d)

Situation

The desk packet is straw-buyer occupancy file after a claims photo EXIF timestamp that predates the loss. Claims special-investigation lead in a P&C carrier's auto-body network has to name Remove access or reverse the item or Temporary compensating control for this Fraud Detection Payments Fraud file.

Decision

Claims special-investigation lead 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 straw-buyer occupancy file after a claims photo EXIF timestamp that predates the loss.

Hypotheses to test

• Straw-buyer occupancy file reads as Remove access or reverse the item once a claims photo EXIF timestamp that predates the loss is lined up to the same Fraud Detection population.
• Straw-buyer occupancy file is closer to Temporary compensating control after a claims photo EXIF timestamp that predates the loss; Remove access or reverse the item would over-claim this Payments Fraud extract.
• Approve a documented exception is still live in straw-buyer occupancy file for claims special-investigation lead in a P&C carrier's auto-body network.
• Straw-buyer occupancy file is missing the fact claims special-investigation lead needs after a claims photo EXIF timestamp that predates the loss; stop this Fraud Detection close.

Analysis required

• Trace funds, counterparties, and reversals in straw-buyer occupancy file through the window opened by a claims photo EXIF timestamp that predates the loss.
• Quantify loss if the hold is released before straw-buyer occupancy file is complete.
• Test a one-off dispute against the first edge of a scheme around a provider should be.
• For this Fraud Detection Payments Fraud file, read straw-buyer occupancy file against a claims photo EXIF timestamp that predates the loss and write the one fact that would move a provider should be for claims special-investigation lead.

Recommendation

The actionable close on straw-buyer occupancy file is Remove access or reverse the item if a claims photo EXIF timestamp that predates the loss left a complete Payments Fraud trail; otherwise Temporary compensating control. Claims special-investigation lead should cite the specific line in straw-buyer occupancy file that settles a provider should be before anyone else acts in a P&C carrier's auto-body network.