Assess whether to refer to law enforcement or keep civil (d1485f)

SITUATION Claims and Benefits Fraud work in a P&C carrier's auto-body network now turns on to refer to law because a customer calling to reverse a 'authorized' card charge put workers'-comp claimant attorney cluster in play. Bank BSA/AML case manager should say what workers'-comp claimant attorney cluster proves.

DECISION Bank BSA/AML case manager in a P&C carrier's auto-body network must choose To refer to law enforcement / Keep civil using workers'-comp claimant attorney cluster after a customer calling to reverse a 'authorized' card charge.

HYPOTHESES TO TEST 1. A customer calling to reverse a 'authorized' card charge is noise around an already-controlled Claims and Benefits Fraud process in a P&C carrier's auto-body network, given workers'-comp claimant attorney cluster. 2. A customer calling to reverse a 'authorized' card charge is the event in workers'-comp claimant attorney cluster that forces To refer to law enforcement for bank BSA/AML case manager under Fraud Detection. 3. Workers'-comp claimant attorney cluster shows a one-file miss after a customer calling to reverse a 'authorized' card charge, not a Claims and Benefits Fraud program failure. 4. Workers'-comp claimant attorney cluster cannot decide to refer to law yet after a customer calling to reverse a 'authorized' card charge; hold is the only Fraud Detection close a P&C carrier's auto-body network can defend.

ANALYSIS REQUIRED 1. Quantify loss if the hold is released before workers'-comp claimant attorney cluster is complete. 2. Test a one-off dispute against the first edge of a scheme around to refer to law. 3. Check mule or round-trip markers in workers'-comp claimant attorney cluster. 4. For this Fraud Detection Claims and Benefits Fraud file, read workers'-comp claimant attorney cluster against a customer calling to reverse a 'authorized' card charge and write the one fact that would move to refer to law for bank BSA/AML case manager.

RECOMMENDATION Choose To refer to law enforcement / Keep civil on this Fraud Detection / Claims and Benefits Fraud packet (workers'-comp claimant attorney cluster after a customer calling to reverse a 'authorized' card charge). Lead with the Fraud Detection option workers'-comp claimant attorney cluster can support after a customer calling to reverse a 'authorized' card charge, 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.

COMMAND RETURNS - Bottom-line Fraud Detection option on to refer to law, then the evidence in workers'-comp claimant attorney cluster, then the action for bank BSA/AML case manager - Hypothesis scorecard against workers'-comp claimant attorney cluster: supported / rejected / untestable - Regulatory or exam hook Claims and Benefits Fraud would cite - Claims and Benefits Fraud finding in workers'-comp claimant attorney cluster that a second reviewer can re-perform