Source context
The relevant claims inputs, identifiers and scope remain visible so an investigator can tell what the analysis covered.
Approach
Sequrin's four-step claims-integrity workflow
This is the canonical path used across the product: connect the data needed for a defined question, detect activity that merits attention, investigate with the context attached, and route the outcome through the organisation's accountable process.
The workflow
Connect, detect, investigate and decide.
- 01
Connect the relevant data
Bring the claims and reference data needed for the question into an analytical context scoped to the organisation doing the work.
- 02
Detect unusual activity
Apply rules, statistics, models and relationship analysis to prioritise activity for closer review, with the reason for each signal attached.
- 03
Investigate in context
Authorised investigators examine the claims, connected entities, timeline, relationships and supporting evidence without reconstructing the story from scattered alerts.
- 04
Decide through the accountable process
Record the investigative outcome and pass any consequential action through the organisation's authorised people, rules and review channels.
Start with evidence
One bounded question is enough to learn something useful.
A sensible evaluation starts with a specific claims-integrity question, the data needed to test it and a clear view of who can access the work.
Then measure what investigators actually care about: whether the signal was relevant, whether the connected context helped, how much noise came with it and whether the workflow made the review easier.
What carries forward
Each handoff should add context, not discard it.
Signal rationale
Triggered rules, scores and connected activity travel with the lead instead of arriving as an unexplained alert.
Review history
Evidence, notes and material case activity create a record that another authorised reviewer can follow later.
For medical schemes
Evaluation criteria for a working integrity team
A medical scheme can assess signal relevance, the usefulness of connected context, noise and the fit with its existing review practice.