Claims fraud
A claim that repeats another claimant's details becomes a case.
Staged losses, inflated repairs, and provider rings show up as the same phone, address, or bank account under a second name. OptiArms reads the claims you file and says where it has seen them before.
What you send
Records you already keep, posted from the systems that already hold them. Nothing is installed, and nothing of yours is crawled.
- Claims
- From your claims system, when one is filed and again when it changes.
- Claimants and providers
- The parties on the claim, with the contact details you already hold.
- Documents
- A hash and the metadata of what was submitted, so the same estimate arriving twice is visible.
- Payments
- Where the money went, so a repeated account under a new name reads as one.
What comes back
A case for a person, with the reasons beside it. Never a percentage, and never a decision this platform made on your behalf.
A case, with its reasons
One case per claim per question, holding every signal that reached it and the evidence behind each.
A band, never a number
Possible, probable, or critical, recomputed from the signals on the record. No score is published as a percentage.
A flag on your record
If you wire one up, a webhook annotates the claim in your own system. Nothing is held unless you ask for a hold.
A record of the decision
Who looked, what they concluded, and when. Appended to a chain nobody can rewrite, including us.
The first hours
The same four steps whatever the claim or claimant is. Each one is recorded, including the rules that found nothing.
01
The claim lands
Your system posts it. The claimant, the provider, and the policy become records, and their details join the ledger.
02
The rules read it
Each rule that fires writes one sentence and attaches what it saw. Each rule that does not fire is recorded too.
03
The case opens
Above the floor you set, a case opens and your investigations queue is paged.
Below it, the signals stay on the record and page nobody.
04
A person decides
Confirmed, not fraud, or inconclusive. That verdict is what your own false-positive rate is counted from.
What your compliance team asks
Answered here rather than in a call, because these are the four that decide whether a review goes any further.
Where the data comes from
The claims you send, plus public records. Anything bought about a phone number is bought for fraud prevention and audited per lookup.
What we never do
No coverage decision and no denial. A case is a prompt for your investigator, and the file stays yours.
What a claimant is told
Nothing by us. A claimant never receives a reason, a score, or a notice from this platform.
Who can read a case
The people you put on the roster, under your organization, scoped by the same predicate on every statement.
Start with one lane, not the network.
One source of events, in shadow, scoring claims and claimants against rules you can read before anything reaches anybody. Insurance and claims is where the first cases come from.