Assess whether a SAR narrative is supportable today (31ec51)

Situation

A customer calling to reverse a 'authorized' card charge put straw-buyer occupancy file 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 straw-buyer occupancy file, 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 straw-buyer occupancy file after a customer calling to reverse a 'authorized' card charge.

Hypotheses to test

• Straw-buyer occupancy file reads as Remove access or reverse the item once a customer calling to reverse a 'authorized' card charge is lined up to the same Fraud Detection population.
• Straw-buyer occupancy file is closer to Temporary compensating control after a customer calling to reverse a 'authorized' card charge; Remove access or reverse the item would over-claim this Credit and Identity Fraud extract.
• Approve a documented exception is still live in straw-buyer occupancy file for claims special-investigation lead in a Medicare Advantage claims shop.
• Straw-buyer occupancy file is missing the fact claims special-investigation lead needs after a customer calling to reverse a 'authorized' card charge; stop this Fraud Detection close.

Analysis required

• Trace funds, counterparties, and reversals in straw-buyer occupancy file through the window opened by a customer calling to reverse a 'authorized' card charge.
• 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 SAR narrative is.
• For this Fraud Detection Credit and Identity Fraud file, read straw-buyer occupancy file against a customer calling to reverse a 'authorized' card charge and write the one fact that would move a SAR narrative is for claims special-investigation lead.

Recommendation

Choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold on this Fraud Detection / Credit and Identity Fraud packet (straw-buyer occupancy file after a customer calling to reverse a 'authorized' card charge). The follow-on Credit and Identity Fraud action is what claims special-investigation lead does next: implement the option, assign an owner, and log the missing fact.