Claims lifecycle · Stage 04 of 08 · Investigation & evidence
Insurance fraud investigation software that finishes the investigation
Every suspicious claim gets the full workup, not a score and a place in the queue.
In short
Hesper AI is an AI claims resolution platform for P&C carriers, TPAs, and MGAs. Its investigation agents take a suspicious claim and run 15+ phases in parallel - document forensics, database and index-bureau checks, OSINT, statement cross-referencing, network analysis - then hand your SIU a sourced, audit-ready file. The investigator keeps the finding, the referral, and the denial decision.
Why do most flagged claims never get investigated?
Detection is not the constraint. A scoring tool can flag more claims in a morning than an SIU can work in a quarter, and a score is not an investigation: someone still has to pull the records, check the databases, read the statements, and write the file. At a manual pace of 14+ days per case against 200+ open cases per investigator (Hesper internal benchmarks), most flags are closed on judgment rather than evidence.
That is the gap Hesper closes. Not a better score, but the work that has to happen after the score.
What do the investigation phases cover?
15+ phases run at the same time on a suspicious claim, because software attention is not the bottleneck a human's is:
- Triage and red-flag detection, then a structured investigation plan for the claim in front of it.
- Document collection and forensics: tampering, synthetic and AI-generated documents, pixel and metadata analysis.
- Database and index-bureau checks against NICB, ISO ClaimSearch, DMV, NMVTIS and similar sources.
- Entity and context verification: identities, businesses, licences, vendors, claimed relationships.
- Background research, social media and OSINT, and scene and surveillance material where it exists.
- Statement and recorded-interview analysis, EUO preparation, and timeline reconstruction.
- Forensic analysis of billing and financials, and network analysis across shared doctors, lawyers, and body shops.
- Case narrative and report assembly, with denial justifications and referral documents drafted.
What does the investigator get back?
An evidence file, not an alert: an executive summary, the evidence with its sources, a reconstructed timeline, statement analysis with the inconsistencies called out, risk scoring with the reasoning behind it, and a recommended next action. Every assertion points back to the document, record, or photo it came from, with a timestamp.
That is what a documented-decision requirement asks for, and it is the part a manual file usually cannot produce months later. Your SIU lead reviews the file and signs the conclusion.
How does it work with FRISS, Shift, or Verisk?
Hesper has fraud detection built in, so it can run standalone. Where a carrier already runs a detection vendor, Hesper works downstream of it: their score flags the claim, Hesper investigates it end to end. Carriers commonly run both, and nothing about the existing referral process has to change.
Compare the layers on FRISS alternatives and Shift Technology alternatives.
Where does investigation sit in the claims lifecycle?
Investigation is stage four of eight. The evidence gathered here is the same file that supports the coverage position, the settlement valuation, and the subrogation demand later on, and the signals that start it are picked up at intake and triage.
See all eight stages on the claims lifecycle overview.
What does Hesper do, and what does your team decide?
| Hesper's agents | Your team |
|---|---|
| Runs 15+ investigation phases in parallel on every suspicious claim | Decides which claims are worth referring |
| Assembles the sourced, timestamped evidence file | Reviews the evidence and signs the conclusion |
| Drafts denial justifications, referral and filing documents | Makes the denial, referral, or payment decision |
| Flags network patterns across claims | Chooses when to escalate to law enforcement or counsel |
What does the output look like?
- Claim
- Single-vehicle loss reported three days after the date of loss, soft-tissue injuries claimed
- Document forensics
- Repair invoice metadata shows the PDF was edited after the stated issue date
- Database checks
- Two prior claims at the same address under a different name
- Network analysis
- Treating clinic and attorney appear together on eleven other open claims
- Statements
- Recorded statement places the vehicle on a road closed on the date of loss
Evidence cited
- Invoice edit timestamp, with the document and page cited
- Prior-claim records returned by the index bureau check
- Clinic and attorney overlap shown across the eleven claims
Recommended next action: Refer to SIU with the assembled file; investigator reviews, decides on examination under oath, and signs the conclusion.
Frequently asked questions
What is insurance fraud investigation software?
Software that does the investigative work after a claim is flagged: retrieving records, checking industry databases, analysing documents and statements, mapping networks, and assembling the evidence file. Detection software decides which claims look suspicious; investigation software works out what actually happened and documents it.
Does Hesper replace SIU investigators?
No. It removes the assembly work and hands investigators a complete, sourced file. The finding, the referral, the denial, and anything that goes to a regulator or law enforcement stay with your SIU. Investigators review evidence instead of gathering it.
Do we have to drop our detection vendor?
No. Hesper has detection built in and can run standalone, but it also runs downstream of FRISS, Shift, Verisk, or an internal model. Their score flags the claim; Hesper investigates it and returns the file.
Can the output support a referral or a regulator's review?
The file is built to be reconstructable: every assertion cites its source with a timestamp, and the reasoning is recorded rather than implied. Your SIU lead reviews and signs it, and your compliance team decides what is filed, as they do today.
Which lines of business does it cover?
Auto, property, workers' compensation, general liability, and pet claims, in personal and commercial lines. The red flags and the phases that matter differ by line, and the agent adapts its plan to the claim in front of it.
Other stages of the claim
Book a demo of Hesper's investigation agents
A 30-minute walkthrough on your claim types: from a flagged claim to a signed, sourced file.
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