Exhibit · the model
Claims Investigation ROI Model
Two ways the platform pays for itself - capacity it frees today, and fraud leakage it recovers. Set your numbers; the case builds itself.
Blended return
10.5×
at 50% fraud recoveryStart from
AYour claims operation
The numbers you know
Five figures a claims leader can answer cold. Drag or type.
/yr
$
FTE
$
$
Avg claim paid
$800
Claims / FTE
2,667
Handling $/claim
$32
1Operational efficiency - the floor
What it returns before a single fraud is caught
Drawn from both spend pools: labor capacity reclaimed plus point-tool spend retired.
Labor - capacity reclaimed
$382,500
Software - tools retired
$120,000
Total efficiency value
$502,500
Floor return
2.5×
Payback
4.8 mo
Capacity freed
4.5 FTE
4.8 moEfficiency alone pays for the platform in that time. Every dollar of fraud recovered is upside.
2Fraud recovery matrix - what you have to believe
How much of the fraud does Hesper need to catch?
At 10% fraud in the book - $3.2M on $32M paid - here is what each recovery level returns, stacked on the floor. Pick the level you would defend.
Hesper recoversFraud recoveredBlended valueReturn
3The case
$2.1M back in your book every year.
Efficiency alone pays for the platform in 4.8 mo. Recovering 50% of the fraud in your book takes the return to 10.5×.
Efficiency $503KFraud recovered $1.6M
0$1.1M$2.1M
Value returned / yr
$2,102,500
Model · 30% of SIU labor cost returns as reclaimed capacity · 100% of displaceable point-tool spend retired · fraud at 10% of net claims paid · directional, not a quote