Fraud Case Management Software for Insurers, TPAs and SIU Teams
Manage referrals, investigations, intelligence and outcomes in one AI-powered workbench — with a full audit trail behind every decision.
Spreadsheets Weren't Built to Run a Fraud Operation
Most fraud teams still track cases in Excel, inboxes and disconnected portals — referrals slip, cycle times stretch, and savings are hard to evidence at board level.
What Fraud Case Management Software Should Do
Referral Management
Capture referrals from claims handlers, detection systems and direct intake into one structured, prioritised queue — with 360° feedback to referrers.
Investigation Case Management
Run the full case lifecycle — tasks, evidence, strategy, financials and outcomes — with configurable workflows and SLA tracking at every step.
Intelligence Management
A secure intelligence repository with entity matching across parties, past cases and watchlists — alerts when a new case touches known risks.
AI Agents, Human Decisions
Case Handler, Intel and Investigation Assistant agents automate the repetitive work — investigators always make the determination.
Evidence Management
Centralise all evidence — documents, audio, video — with version control, access permissions and chain of custody.
Audit & Compliance
Every action, decision and search automatically logged — a defensible trail for FCA Consumer Duty and legal review.
Track Every Case From Referral To Resolution
A structured six-stage workflow with SLA enforcement, mandatory checkpoints, and a full audit trail from first referral to final closure.
Referral
✓Intake Form
✓Risk Score
✓Source Log
Assessment
✓Initial Review
✓Classification
✓Assignment
Investigation
Interviews
Field Work
Data Queries
Evidence Review
Doc Analysis
Verification
Linking
Decision
Outcome
SIU Report
Recommendation
Closure
Archiving
Recovery Log
Audit Trail
Complete Visibility Across Your Fraud Operation
Single Source of Truth
All referral data, case history, evidence, and communications unified in one operational system.
Operational Oversight
Real-time visibility for managers across team workloads, bottlenecks, and financial outcomes.
Investigation Consistency
Standardised workflows and SLA enforcement ensure every case is handled correctly, every time.
Audit Readiness
Immutable logs of every action, decision, and piece of evidence for regulatory compliance.
Results That Speak For Themselves
95%
Reduction in Outstanding
Referrals
25-30%
Faster Investigation Completion
50,000+
Settled
Investigations
£150m+
Suspected Claims Managed
Works With Your Existing Fraud Ecosystem
FraudOps connects with your claims systems, detection platforms, and data sources — no rip-and-replace required.
