Insurance Agent Fraud Detection

Rule Activation

RB-01 High loan-to-premium with agent involvement

RB-02 Missing payer on high premium receipts

RB-03 Rapid status deterioration (I → L)

RB-04 Family network concentration

RB-05 Overdue but not reconciled

Threshold Configuration

High loan-to-premium thresholdCritical loan-to-premium thresholdHigh premium amount thresholdMinimum missing payer receiptsRapid status window (days)Family connection count thresholdFamily policy concentration thresholdOverdue high severity (days)Overdue critical severity (days)Supervised fraud probability thresholdCase minimum queue scoreCase queued scoreCase in-review scoreCase escalated score

Anomaly Weighting

Loan ratio weight0.22

Payment behavior weight0.20

Payer identity weight0.18

Status transition weight0.16

Network feature weight0.12

Rule score weight0.12

Live Impact Snapshot

Rule Alerts

High Anomaly Cases

High Supervised Risk

Escalated Cases