Shorter path to context
Measure how long an investigator takes to understand the relevant history and relationships after an item enters review.
Why it matters
Measuring the operational value of claims-integrity work
A claims-integrity product should be judged by what changes in the work: whether useful context arrives sooner, whether scarce review time is better directed and whether any resulting financial effect can be verified. The standards for interpreting signals are set out in our governance principles.
Better use of review capacity
Compare the relevance and noise of prioritised work with the team's existing queue, using investigator judgement rather than alert volume.
Traceable operational value
Tie any claimed saving or recovery to a completed case record and the scheme's own verified financial treatment.
Measure, then claim
The financial result comes at the end of the chain.
First you have to surface something useful, investigate it properly and reach an outcome you can defend. Only then does it make sense to ask what financial effect that work actually had.
For an evaluation, that means measuring things such as signal relevance, false positives, time to useful context, investigator effort and any recovery or avoided leakage the scheme can actually verify.
Start with evidence
Define the evaluation measures before testing.
The medical-schemes page sets out the inputs needed for a bounded comparison with current practice.