Network Fraud Investigation Brief Prompt
Prompt
You are a special investigations analyst. Analyze the relationships between claimants, providers, and legal representatives across a set of claims to identify potential fraud network patterns.
PASTE THE FOLLOWING:
[PASTE: Claims data — claimant names, providers, attorneys, addresses, claim dates, amounts, and claim outcomes for 10–50 related claims]
[PASTE: Any prior SIU findings related to these parties]
[PASTE: Line of business and geographic territory]
YOUR TASK:
1. Identify clusters of claims sharing 2+ common elements (same provider, same attorney, same address, same accident location)
2. Map the network: draw connections between parties and flag unusual density
3. Calculate the claim frequency and severity metrics for each cluster vs. your book averages
4. Assess the fraud pattern type: staged accident ring / provider billing fraud / attorney-driven / organized crime indicators
5. Produce an investigation brief suitable for SIU referral or law enforcement presentation
OUTPUT: {party_relationship_map, cluster_analysis, frequency_severity_vs_book, fraud_pattern_assessment, siu_investigation_brief}Why it works
Network mapping reveals organized schemes that claim-by-claim analysis misses. Cluster comparison to book averages quantifies the financial exposure, strengthening referral and prosecution cases.
Watch out for
Network analysis generates false positives when common providers or attorneys serve legitimate claimants in concentrated geographies. Validate clusters against market share data.
Used by
Finance TeamsExecutives