Workflow — SIU Document Review

Fraud-flagged file review in hours, not weeks.

Claim files with fraud indicators — timeline reconstruction across statements, ISO ClaimSearch cross-reference, prior-claims pattern detection, public-records cross-check. SIU referral packet and recommendation memo into Guidewire, Duck Creek, or Origami. Replaces SIU vendor desk reviews at a fraction of the per-investigation cost.

Take the AI Assessment Get a Per-Investigation ROI Model

$400–$1,500

Per investigation at the SIU vendor desk

7–21 days

Typical desk-review backlog at vendor intake

60–85%

Volume off the SIU vendor line after AI cutover

What This Replaces

The SIU Vendor Desk on Every Fraud-Flagged Claim

The work the SIU vendor does on every fraud-flagged file — and the cost of leaving it there.

The labor

SIU document review today moves through vendor desk-review teams at Verisk, Mitchell, ISO, and adjacent SIU services firms. Per-investigation cost runs $400–$1,500 depending on file complexity, public-records pulls, and witness-interview reconstruction. A mid-size carrier processing 5K–10K SIU referrals per year routinely spends mid-seven figures on desk-review work alone.

The cycle time

Standard SIU desk-review turnaround runs 7–21 days at the vendor, with longer cycles when the file requires public-records aggregation, social-media collection, and timeline reconstruction across multiple recorded statements. Every week a fraud-flagged claim sits in the desk-review queue is a week the in-house SIU team can't make the deny / investigate further / pay determination — and a week the carrier carries reserves on a claim that may not be valid.

The Workflow

Input · Analysis · Output

What goes into SIU desk review, what we do to it, and what shows up on the SIU desk.

Input

Fraud-flagged claim file

Claim file flagged at FNOL or during adjuster handling
Recorded statements (claimant, witnesses, prior-claim parties)
Social-media evidence and public-records data
Prior-claims history per claimant (ISO ClaimSearch)
Adjuster fraud-indicator notes
Police reports, body-shop estimates, photos
Policy and coverage detail at time of loss

Analysis

Reconstruct, cross-reference, recommend

Timeline reconstruction across all statements
Inconsistency detection between statements and physical evidence
ISO ClaimSearch cross-reference for prior-claim patterns
Public-records cross-check (DMV, court, business filings)
Social-media evidence scoring against claim narrative
Fraud-indicator scoring per industry taxonomy
Confidence score per indicator; exceptions to SIU specialist queue

Output

SIU referral packet into the SoR

Guidewire ClaimCenter (REST API or EDGE)
Duck Creek Claims (OnDemand APIs)
Origami Risk (REST API)
SIU referral packet with timeline and evidence index
Recommendation memo (deny / investigate further / pay)
Suspicious-activity tags for fraud reporting
Indicator-level audit trail per investigation

Side by Side

SIU Document Review Today vs. With Last Rev

The numbers that matter: cycle time, per-investigation cost, accuracy, and audit posture.

Dimension	SIU Vendor Desk	Last Rev SIU Document Review
Cycle time, fraud flag to recommendation	7–21 days at vendor desk	4–8 hours per file
Per-investigation unit cost	$400–$1,500 per investigation	Per-file, benchmarked at 25–45% of vendor unit cost
Surge handling on CAT-driven fraud surges	Vendor backlog grows, response time slips	Elastic by design — same indicator taxonomy applied at scale
Audit log per indicator	Vendor narrative, no indicator-level lineage	Source statement + indicator basis + model version + confidence per finding
Cross-reference completeness	ISO ClaimSearch + manual public-records pulls	ISO ClaimSearch + DMV + court records + business filings + social-media in one pass
Claims-system integration	Vendor portal handoff, separate reporting	Direct via documented Guidewire / Duck Creek / Origami APIs
Renegotiation leverage at next SIU vendor renewal	None — you're locked in	60–85% of desk-review volume off the contract

How It Works

From Fraud Flag to SIU-Ready Recommendation

Five steps. Every one logged. Every one reversible if your confidence threshold isn't met.

Submission Lands

Fraud-flagged claim file from Guidewire ClaimCenter, Duck Creek, or Origami — with recorded statements, prior-claims history, social-media evidence, public-records data, and adjuster indicator notes.

Extraction & Classification

Timeline reconstruction across statements. ISO ClaimSearch cross-reference for prior-claim patterns. Public-records cross-check (DMV, court, business filings). Social-media evidence scoring against the claim narrative.

Validation Against Indicator Taxonomy

Findings validated against the carrier's fraud-indicator taxonomy and per-jurisdiction reporting requirements. Anything below your confidence threshold per indicator is routed to a human exception queue — your call which queue, ours or yours.

Push to System of Record

SIU referral packet with timeline and evidence index. Recommendation memo (deny / investigate further / pay). Suspicious-activity tags for fraud reporting. All delivered into the claims system via the documented integration.

Audit Log Persisted

Every indicator finding, cross-reference event, and timeline-reconstruction step logged with the source statement, model version, prompt, and confidence score. Discovery-ready, DOI-exam-ready, and yours.

Compliance & Defensibility

Built to Meet the Quality Bar SIU Operations Already Run On

State DOI fraud-reporting standards

Suspicious-activity tags align with state DOI fraud-reporting requirements (NICB referral, state insurance-fraud-bureau notification). The audit log produces the basis for any reportable referral on demand.

ISO ClaimSearch cross-reference

Prior-claims history pulled and reconciled against the current claim narrative at intake. Cross-claim patterns surfaced with the matching evidence cited so the SIU desk has the basis for further investigation in one place.

No determination authority

We don't make the SIU determination — we tag the claim with the indicators and source evidence so your SIU team makes the call on a richer file than they get from the vendor desk today. The recommendation memo is advisory, not binding.

PII and investigative confidentiality

Fraud investigations contain claimant PII, social-media content, and pre-determination work product. Deployable in your VPC or our SOC 2 environment. Encryption in transit and at rest; retention policies tied to your DOI guidance and state-specific record-retention rules.

Common Questions

What Carriers Ask About SIU Document Review

Verisk, Mitchell, ISO, and adjacent fraud-data vendors provide the cross-reference data and have improving in-platform fraud features. The competitor on this page is the SIU vendor desk-review labor line on your operating budget — typically $400–$1,500 per investigation at vendor desks, often the same firms that supply the data. We undercut that desk-review labor cost, integrate directly into your existing claims system, and deliver SIU referral packets and recommendation memos into the system of record. We use the same data sources you already license — we don't replace them, we accelerate the analyst work that sits on top of them.

Most carriers keep the SIU vendor in place during pilot and early production — we route exceptions, complex multi-claimant rings, and any case that genuinely requires senior-investigator interview work to the team you already have. Volume to the vendor drops 60–85% on routine desk-review once cutover completes. You renegotiate at the next renewal from a much better position, or shift the relationship to higher-complexity work like field investigations.

Our pilot success threshold is fraud-indicator extraction and timeline-reconstruction accuracy at parity with or above your incumbent SIU vendor, measured on the same shadow-data sample of fraud-flagged files. Anything below your defined confidence threshold per indicator is routed to a human exception queue — your call which queue, ours or yours.

We don't make the SIU determination. We tag the claim with the indicators and source evidence so your SIU team makes the call on a richer file than they get from vendor desk today. The recommendation memo is advisory — every indicator traces back to the source statement, document, or cross-reference so the SIU desk can make the call on the underlying evidence.

Social-media collection happens through licensed providers your team already uses. Public-records pulls (DMV, court records, business filings) happen through documented data sources with the per-record citation and retrieval timestamp recorded. The audit log produces the source for any piece of evidence in the recommendation memo.

Yes — through the documented integration surface each platform supports. Guidewire via the ClaimCenter REST API or EDGE; Duck Creek via OnDemand APIs; Origami Risk via the REST API. Your IT team reviews and approves a service account, and we connect through the documented integration. We do not require platform-side custom development.

SIU pilots typically run 6–8 weeks: 1–2 weeks of integration and indicator-taxonomy mapping with the SIU team, 4 weeks of shadow-mode running on real fraud-flagged files with no system-of-record writes, 1–2 weeks of supervised cutover on a constrained scope (one LOB, one region). Production rollout is staged after the pilot meets your accuracy and SLA bar.

We benchmark against your current per-investigation vendor cost — typically $400–$1,500. Our target is 25–45% of that per-investigation cost at higher accuracy and faster cycle time. Pricing structures around volume tiers and outcome SLAs, not hourly billable rates.

Two Ways to Start

Take the AI assessment for a structured read on SIU desk-review feasibility. Or talk to us if you already know your SIU vendor is the bottleneck on fraud disposition.

Self-serve · 8 minutes

Take the AI Assessment

A short structured assessment that maps your monthly fraud-flagged volume, current SIU vendor, and claims system to AI feasibility and ROI.

Talk to a specialist

Get a Per-Investigation ROI Model

Send us your monthly fraud-flagged volume, current SIU vendor, and target system of record. We'll come back with a per-investigation unit-cost comparison and a 6–8 week pilot plan in 5 business days.

Other Workflows

More Insurance Workflows We Replace

The same approach, applied to the other claims-document labor lines on your operating budget.

FNOL Intake

First-notice-of-loss extracted, validated, and pushed into Guidewire, Duck Creek, Origami, or Snapsheet in minutes.

Subrogation File Review

Closed claim files triaged for subrogation viability, SOL dates, and recoverable-amount calculations.

Demand Package Review

Attorney demand packages — claim valuation drivers and reserve recommendations in days, not weeks.

CAT Claims Surge

High-volume FNOL post-storm — triaged, validated against pre-loss imagery, and batch-routed at scale.