Fraud alerts, explained and audited
Scoring models rank risk; they don’t explain it. This reference solution puts an agent on top: it reads the flagged event, the history, and the relevant typologies, then produces a cited narrative of why the case looks fraudulent — or why it doesn’t. Your investigators work from a reasoned recommendation instead of a bare score, and every assessment is auditable.
Where it fits
Transaction fraud
Reads a flagged transaction in the context of the customer’s pattern and prior alerts, and explains the deviation in plain, cited terms.
Insurance claim fraud
Assesses a claim against fraud typologies and the claimant’s history, surfacing the specific inconsistencies a fraud analyst would look for.
Application fraud
Cross-checks an application’s documents and declared facts against internal and policy sources, flagging fabrication and identity-mismatch signals.
False-positive triage
Clears the alerts that don’t hold up under scrutiny — with the reasoning recorded — so investigators spend time on the ones that do.
Fraud detection FAQ
Does this replace our fraud scoring model?
No — it sits on top of it. Statistical and ML scoring models are good at ranking risk but poor at explaining themselves. The agent takes a scored alert, reads the surrounding case file and history, and produces a cited narrative of why the event is or isn’t consistent with known fraud patterns.
What does the agent read?
The flagged event, the customer or claim history, prior decisions on the same subject, and the relevant policy or typology documentation. It grounds its assessment in those sources and cites them, rather than asserting a verdict on its own authority.
Does it auto-block transactions or claims?
By design it recommends, with a confidence-floor and policy rules forcing uncertain or high-impact cases to a human investigator. Auto-action thresholds, if any, are the customer’s risk decision — the agent’s role is to make the investigator faster and the rationale auditable.
How is the rationale auditable?
Every assessment writes an immutable record linking the signals considered, the passages cited, the confidence, and the investigator’s confirm or override. That record is reconstructable later — which matters when a fraud decision is challenged or examined.
Want to see this in your environment?
30-minute discovery call. We follow up with a draft SOW shortly after.
Talk to us about a pilot