Claims special-investigation lead must resolve whether a SAR narrative

Situation

A mortgage occupancy affidavit contradicting utility records put check-kiting multi-bank float map in front of claims special-investigation lead in a Medicare Advantage claims shop. This Fraud Detection / Credit and Identity Fraud close is a SAR narrative is from check-kiting multi-bank float map, and the live options are Remove access or reverse the item, Temporary compensating control, Approve a documented exception.

Decision

Claims special-investigation lead in a Medicare Advantage claims shop must choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold using check-kiting multi-bank float map after a mortgage occupancy affidavit contradicting utility records.

Hypotheses to test

• The population in check-kiting multi-bank float map is the one a mortgage occupancy affidavit contradicting utility records named, so Remove access or reverse the item follows for this Credit and Identity Fraud file.
• The population in check-kiting multi-bank float map is adjacent only to a mortgage occupancy affidavit contradicting utility records; Temporary compensating control is the honest Fraud Detection call.
• A Medicare Advantage claims shop already contained a mortgage occupancy affidavit contradicting utility records before check-kiting multi-bank float map arrived; no new Credit and Identity Fraud path.
• Provenance on check-kiting multi-bank float map after a mortgage occupancy affidavit contradicting utility records is broken; do not pick Remove access or reverse the item or Temporary compensating control yet.

Analysis required

• Trace funds, counterparties, and reversals in check-kiting multi-bank float map through the window opened by a mortgage occupancy affidavit contradicting utility records.
• Quantify loss if the hold is released before check-kiting multi-bank float map is complete.
• Test a one-off dispute against the first edge of a scheme around a SAR narrative is.
• For this Fraud Detection Credit and Identity Fraud file, read check-kiting multi-bank float map against a mortgage occupancy affidavit contradicting utility records and write the one fact that would move a SAR narrative is for claims special-investigation lead.

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