Suspicious Claim Referral Agent

Fraud costs insurers money, but wrongly treating an honest customer as a suspect damages trust. As claims are reported, this agent checks for known warning signs: a policy bought days before the loss, repeated claims, inconsistent stories across calls, edited photos or documents that do not match. It checks each sign against the facts on file, since many have innocent explanations, like replacing an old policy after a move. Signs that are explained are dropped. Only claims with at least two confirmed signs are drafted as referrals to the special investigations unit, with the evidence attached. The representative and a supervisor approve every referral. The customer's service continues normally while any review runs. Edge case: a new policy right after buying a new car is not treated as suspicious.