Managing Fraud Information (End User)

End users use the Claims screen, then the SIU Dashboard view to record and track information regarding fraudulent claims. This task is a step in Process of Managing Claims.

Cases of fraud relating to claims are usually handled by a special investigation unit (SIU). An adjuster can assign a claim to a SIU if he thinks there is fraud involved in the claims. One or more investigators in the SIU can then use the Claims screen - SIU Dashboard view to manage the fraud-related activities. A claim can be assigned to various investigators, for example, to arbitration or litigation specialists. Some of the primary fields in the SIU dashboard are described in the following table.

Field	Comments
SIU Referral	Indicates whether the claim has been referred to the SIU.
Referral Source	Identifies how the case was referred to the SIU: System. The case was referred automatically due to the suspicious claim score. Manual - adjuster. An adjuster referred the case manually. Manual - Reassignment. The case was reassigned.
SIU Assignment Date	Displays the time and date on which the claim was assigned to the SIU.
SIU Closed Date	Displays the time and date on which the SIU file was closed.
Stop Payment	Indicates whether the payment is on hold.
Suspicious Claim Score	Displays the combined fraud potential score.
Prob. of Resolution	Displays the probability of resolution value for the claim. This field is set through the Update Probability of Resolution task.
SIU Status	Select the status of the fraud case. Values include: Assigned, Accepted, Initial Review, Negotiations, Decision Pending, Closed, and Re-opened.
SIU Disposition	Select the final status of the fraud case after processing is complete. The values include: Abandoned, Deny, Litigate, Negotiated, Pay.

Some of the fields in the dashboard that display the key financial information are described in the following table.

Field	Comments
Total Claim Payment	Displays the total of payments made on the claim to date.This field is updated by the Recalculate Payment task. Note: The value in this field comes from the Claims, then the Payment view for payments with a type other than Subrogation Expense or SIU Expense.
Total Expenses	Displays the total SIU expenses incurred to date.This field is updated by the Update SIU Expenses task. Note: The value in this field comes from the Claims, then the Payment view for payments with a type of SIU Expense.
Recovery Potential	Displays the recovery potential for the claim. The default value is (Prob. of Resolution % * Total Claim Payment).This field is updated by the Update Recovery Potential task.

Some of the dashboard fields that display the final outcome of SIU investigation are described in the following table.

Field	Comments
Conservation Amount	Displays the total outstanding reserve amount for the claim.This field is updated by the Recalculate Conservation task.
Recovery Amount	Enter the total recovery amount for the claim.
Debt Schedule	Select the debt schedule for the fraud recovery. The values are: Installments and Single Payment.

Some of the fields in the dashboard used for arbitration or litigation referrals are described in the following table.

Field	Comments
Litigation Referral	Indicates whether the claim is assigned to a litigation or arbitration specialist.
Assignment Date	Displays the date and time when the case was assigned to litigation for further pursuit.
Outside Counsel	Select the organization; that is, the external counsel handling the case. If the organization is a business unit, the organization is added to the claims Service Provider list with a role of Fraud/Lit. Provider.
Settlement Range	Enter the minimum and maximum settlement amounts for the fraud case.