Walk a fraud alert from pilot to control
Convert an AI fraud signal into a measured and controlled SIU pilot workflow.
Alert overload The model flags 312 claims. SIU can review 40. Claims leaders worry about false-positive delays. The pilot needs a process control, not a bigger alert list. CRISP-DM + DMAIC Define -> Improve -> Control Define the referral objective, improve routing against capacity, then control the workflow with feedback and stop criteria. More flags Looks productive, creates noise. The model becomes a workflow input, not an interruption engine. Fraud AI must optimize investigator usefulness, not alert volume. 01 Define 02 Improve 03 Control Decision 1 The model outputs a suspicion score.
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