Fraud network analysis that shows every claim a phone, person, clinic or shop touches
Organized rings seen across claims, not missed one claim at a time.
See one case, screen by screen ↓Fraud network analysis, or link analysis, looks at claims together instead of one at a time: it connects the people, phones, addresses, clinics, attorneys, shops, cards and accounts that claims share, so an organized ring shows up as one cluster. Fraud Network Analysis reads those links out of the claim documents themselves and draws them on a map an SIU investigator can ask and expand.
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Staged-accident crews, clinic and runner networks, storm contractors and theft rings reuse the same people, phones, addresses, cards, bank accounts, clinics, attorneys and tow yards across many claims and many policies. But each claim is adjusted on its own. A rear-end collision with three passengers, all treated at the same clinic two days later, with a letter of representation on day five, looks like hundreds of honest PIP claims.
The links that would give it away live inside documents, not in fields anyone can search: the callback number in the first-notice call log, the “referred by” name on the clinic intake form, the attorney on the letter of representation, the tow yard on an invoice, the card that paid the premium in billing. Cross-checking them by hand — one identifier at a time, then a chart drawn by hand — takes weeks. Meanwhile PIP has to be paid or denied on its own clock, and a naive link chart joins everyone through a regional hospital or a national tow dispatch line until investigators stop trusting it.
Estimated split for one ring of about ten claims, by hand and with the solution. The investigator still checks every link at its source.
Six agents read every claim file, link it and find the rings each night; the investigator decides what is a lead.
Monday 12 October, 08:30, at Keywater Insurance Company’s South Florida SIU unit. A rear-end collision in Miami with three occupants comes in as one more referral. Here is what happens next, screen by screen, in the working solution.
Dana opens PA-26-118204: personal auto PIP, loss 14 Sep 2026 at NW 27th Ave and NW 54th St. Three occupants, $2,300 paid, $38,200 reserved, and a policy bound 31 days before the loss. The link map draws the claim in the middle with what it touches around it — and each of those carries a badge: the phone +10 claims, Coral Gate Rehab Center +7, Vance & Arroyo, P.A. +8, Pinecrest Towing +7, Visa ···8812 +5.
“Each of these claims looks fine on its own. That’s the point of them.”
She selects the first-notice caller’s number, (305) 555-0147. It is the callback on 11 first-notice calls and the referral on 6 clinic intake forms, and it appears on no policy, bill or payment. The caller gave three names — “Javier Ruiz”, “J. Ruiz” and “Jay” — which the entity resolver matched to one caller at 0.96, reviewed by Theo Lindqvist.
Expand pulls in everything the phone touches. Ten more claims move in around it, and the ring the agents found overnight is drawn around them, with the two clinics at one billing address, the attorney, the tow yard, the card and the shared apartment. The steps run in view: searched across 212,406 claims, matched the names written different ways, pulled in what those claims share.
“RING R-14 · 11 claims · 31 people · $486,300 connected”
Every line on the map comes from a document. Dana opens the Coral Gate Rehab Center intake form for passenger Darnell Fuentes, dated 16 Sep: “How did you hear about us? Referred by: J. Ruiz 305-555-0147”, attorney Vance & Arroyo. One click adds it to the lead as an exhibit.
Each night the ring finder rebuilds the link map over a 24-month look-back, sets aside 37 hubs — regional hospitals, Keywater’s own numbers, national tow dispatch — and scores groups of claims that share more than chance allows. Five rings are open, 36 claims and $1,007,300 between them; R-14, Coral Gate, is new overnight, with a score of 94.
“A ring is a reason to look, not a finding.”
The ring page lays the losses out in time, 3 Mar to 2 Oct 2026, and puts each claim against each shared link: the phone on 11 of 11, Coral Gate or Palmcrest on all 11, Vance & Arroyo on 9, Pinecrest Towing on 8, seven policies bound fewer than 60 days before the loss, six paid with Visa ···8812.
Back in PA-26-118204, every identifier the link reader pulled is highlighted in its document: “Jay”, a friend of the driver; the callback number; Pinecrest Towing & Recovery. The margin says what each one links to. On the tow invoice, the truck was dispatched at 18:41 — before the first-notice call at 19:42.
The link reader never writes down an identifier that is not in a document.
At 06:12 the ring finder put the phone, the clinic, the billing address and the card on the watch list. At 08:47 the watch-list monitor catches a new first-notice call from (305) 555-0147: caller “Jay”, a loss on Sun 11 Oct, two occupants “going to Coral Gate tomorrow”, a policy bound on 9 Oct. It alerts Dana and Corinne Szabo, the PIP adjuster. Nothing is held.
A hit alerts the investigator and the adjuster — it never stops a claim.
The lead writer drafts the lead from the ring and its documents: a summary in “linked to” wording with no suspect named, a timeline from the first loss on 3 Mar to the new call this morning, three open questions for the investigator — who holds the phone, whether the vehicle damage fits the reported speed, who owns both clinics — and 14 numbered exhibits, each opening its documents.
Dana saves the lead at 08:53 and sends it to Renee Valcourt at 08:55. Renee approves the referral to the state fraud division at 08:58, and the state referral is drafted on day 0 of its 30-day clock. Corinne Szabo keeps handling the claims under the PIP rules.
“If I sign a referral, I want to see where every line on that map came from.”
The same ring, seen by the five people who carry it — from the first claim to the state referral, and the adjuster who keeps paying what the law requires.
Six agents read every claim file, link it and find the rings each night; the investigator decides what is a lead.
Reads first-notice call logs, PIP applications, clinic intake forms, bills, letters of representation, tow invoices and billing records, and pulls out every phone, address, name, card, bank account, plate and provider with the document and line it came from.
Decides when names, phones and addresses written different ways are the same person or place — comparing names, dates of birth, phones, addresses and voice-line IDs.
Each night rebuilds the link map for the 24-month look-back, sets aside hubs, finds groups of at least four claims that share more than chance allows, and labels each ring with the claims, people and dollars it connects and why it was flagged.
Turns a plain question into a search of the link map, opens the documents behind each link and answers in short sentences, each with its source.
Drafts the case lead for a ring: summary, timeline of losses, payments and letters, numbered exhibits linked to their documents, and open questions for the investigator.
Checks every new first-notice call, bill and payment against the watch list, and on a hit alerts the investigator who added the entry and the handling adjuster, with the source.
Decides what is a lead. The agents propose; a named person decides.
Ask about a person, phone, address, clinic, attorney, shop, card or account. Every sentence comes back with the claim and the document it came from.
Who else uses (305) 555-0147?
The number is the callback on the first-notice call for 11 claims from 3 Mar to 2 Oct 2026, given under three names — “Javier Ruiz”, “J. Ruiz” and “Jay” — matched to one caller. It is also the referral on 6 Coral Gate intake forms. It appears on no policy, bill or payment. The eleven claims are Ring R-14: 31 people, $142,600 paid and $343,700 reserved.
Why is Ring R-14 ranked first?
Score 94 from six facts: one phone on all 11 first-notice calls (+32); two clinics at one billing address (+18); one attorney on 9, letters within a week (+14); 7 policies bound under 60 days before the loss (+12); one tow yard on 8 (+10); one card paying 6 new policies (+8). A ring is a reason to look, not a finding.
Which of our claims did Coral Gate Rehab and Palmcrest Medical treat this year?
Coral Gate treated 24 people on 8 claims and Palmcrest 7 people on 3 claims, all in Ring R-14. Both bill from 7300 NW 7th St, Suite 210 with the same billing phone, under different tax IDs. First visits fell within 2 days of the loss on all 11 claims.
Who paid premiums with card ···8812?
Six new policies in six names, each paid by phone with Visa ···8812 and bound 12 to 52 days before a loss: PA-26-108130, -113390, -114906, -116071, -118204 and -119662 — all in Ring R-14.
12 screens from the working solution, on its sample data. Pick one to see it large.
How links are weighed, when a group of claims becomes a ring, what is set aside and who approves are all settings. Changes take effect at the next nightly run after approval.
| Setting | Default | Choose from |
|---|---|---|
| Link weights | Bank account 1.00 · phone 0.90 · card 0.80 · address 0.60 · witness 0.50 · attorney and clinic 0.40 · tow yard 0.30 | Each from 0.00 to 1.00, versioned |
| Merge names automatically at | 0.92 | Compares name, phone, address, date of birth and voice-line ID |
| Send to the fraud analyst between | 0.75 – 0.92 | Reviewed by the fraud analyst; different dates of birth never merge |
| Smallest ring | 4 claims | Your number of claims |
| Score to show as a ring | 70 | Below it, groups are kept but not drawn |
| Look-back and nightly run | 24 months · 02:00 Eastern | Claims by loss date |
| Set aside as hubs | Linked to more than 400 claims · Keywater’s own numbers · national tow and glass dispatch lines | Claim count set; the others on or off; the analyst can add more |
| Referral clock and approver | 30 days · SIU manager | Set per state |
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
“demo” = seen in the working solution, on its sample claim data · “target” = the design goal, measured in the live solution · “estimated” = our estimate of where the days go · “typical” = published figures from the Coalition Against Insurance Fraud: its 2022 study, via the Insurance Information Institute, puts US insurance fraud at about $308.6B a year, $45B of it in property and casualty; it also estimates fraud touches about 10% of P&C losses. Keywater Insurance Company and the people, clinics, firms, shops, phones, cards and addresses named on this page are fictional — characters and sample data in the working solution.
Fraud network analysis, or link analysis, looks at claims together instead of one at a time: it connects the people, phones, addresses, clinics, attorneys, shops, cards and accounts that claims share, so an organized ring shows up as one cluster. Fraud Network Analysis reads those links out of the claim documents themselves and draws them on a map an SIU investigator can ask and expand.
Each night the ring finder rebuilds the link map over the look-back, sets aside hubs that link everyone — regional hospitals, the carrier’s own numbers, national tow dispatch lines — and scores groups of at least four claims using the link weights in Settings. Groups at or above the threshold are drawn as rings, labelled with the claims, people and dollars they connect and the facts that raised the score.
Yes. The entity resolver compares names, dates of birth, phones, addresses and voice-line IDs, so “Javier Ruiz”, “J. Ruiz” and “Jay” on the same callback number become one caller. It merges on its own only at 0.92 confidence or above, sends 0.75–0.92 to the fraud analyst, and never merges different dates of birth.
No. A ring is a reason to look, not a finding. The agents never call anything fraud, never name a suspect, never hold a payment and never contact anyone. The investigator decides what is a lead, and the SIU manager approves every referral.
Yes. Every line on the map carries the claim, the document and the line it was read from. Open it and the first-notice call log, intake form, letter of representation, tow invoice or payment record opens with the passage highlighted, and it can be added to the lead as an exhibit.
No. Watch-list hits alert the investigator and the handling adjuster; they never stop a claim or a payment. The adjuster keeps every claim decision under the PIP rules.
Yes. Link weights, name-matching thresholds, the smallest ring, the score to show a ring, the look-back, the nightly run, the hubs set aside, the approver and the referral clock per state are all settings. Rule and weight changes need two people — the fraud analyst and the SIU manager — and take effect at the next nightly run.
The Agentic Solution Engine builds and deploys it from your requirements and documents — your SIU procedures, referral requirements and a sample of claim files — and it goes live once every quality gate has passed. We will walk you through it on your own claims first.
Referrals in days, not weeks, after first notice, each with its evidence.
1-min demoDocument Fraud DetectionEvery claim document over a set amount tested for edits before it is paid.
1-min demoContractor Fraud DetectionContractor clusters raised before payment, not found after it.
1-min demoWe’ll run Fraud Network Analysis on a sample of your own claim files.