Test a fraud pattern hypothesis before it is acted on
For: Special investigations lead examining a suspected organised pattern across referred files
The pain today
A suspected pattern, such as the same repairer invoices across many files, is persuasive once stated. Acting on it wrongly delays honest customers, and nobody has time to argue the innocent explanation file by file.
The ask
“I attached the documents from the claim files in my referral and my written hypothesis about a shared repairer invoice pattern. Build the evidence for it from the documents, then try to break it with innocent explanations the same documents support. Show what survives, with sources.”
Plain words, as you would say it to a colleague. Edit it to fit your case before you send it.
What you attach or connect
- Documents from the already referred claim files
- The written hypothesis
- Supplier invoices and estimates
- Investigation guideline
The unit of work
One worker task per one referred file's documents against the hypothesis.
Why a swarm fits
Each file is read alone against one written hypothesis. A separate team with the opposite brief reads the same file, so the case for and the case against are built with equal effort.
Not for
Scoring or flagging individual claims or customers. It tests one written hypothesis against files an investigator already referred.
The decision tree
6 typed decisions, each with an action for every answer
At fixed moments in a run, the engine puts one narrow question to a decision model. The decision model never writes text: it answers yes or no with a probability, picks from listed options, or gives a score, about a small slice of the material. The engine then does exactly what this tree says, which is what makes the run auditable. The thresholds are the template's design values, not measured results.
Planner, while planning
Scope checkYes or no, with a probability
Before work starts on a unit
Is this statement of the hypothesis about what documents show, such as invoice details or dates, and free of any reference to a person's characteristics?
Sees only: One statement from the planner's breakdown of the hypothesis
Why: Statements about people rather than documents are refused before any file is read.
- Yes: 0.85 or higherthenAccept
- Unsure: 0.60 up to 0.85thenAsk a person
- No: below 0.60thenSkip this unit
After workers, the judge checks
Evidence checkYes or no, with a probability
After a worker answers
Does the quoted invoice, estimate or file note contain the specific detail the supporting team says matches the pattern?
Sees only: One hypothesis statement and the quoted document extract offered in support
Why: A pattern built on misread invoices would wrongly hold up honest customers.
- Yes: 0.85 or higherthenAccept
- Unsure: 0.50 up to 0.85thenMark unresolved
- No: below 0.50thenReject and retry
Evidence checkYes or no, with a probability
After a worker answers
Does the quoted document extract support the ordinary explanation the breaking team offers for the same detail?
Sees only: One hypothesis statement, the detail in question and the extract offered against it
Why: The innocent explanation is held to the same evidential standard as the suspicion.
- Yes: 0.85 or higherthenAccept
- Unsure: 0.50 up to 0.85thenMark unresolved
- No: below 0.50thenReject and retry
Reconciler, while merging
Conflict checkA choice among options
While reconciling
On the accepted extracts from both teams, how does this statement of the hypothesis stand?
Sees only: One statement with the accepted supporting and opposing extracts
Why: Keeps balanced and thin statements open rather than letting a persuasive story win.
- Survives the objectionthenAccept
- Broken by the objectionthenAccept
- Evidence evenly balancedthenMark unresolved
- Rests on a single filethenMark unresolved
Run control, between rounds
Another round?Yes or no, with a probability
Between rounds
Did the most recent batch of referred files change the standing of any statement of the hypothesis?
Sees only: Statement standings before and after the last batch
Why: Stops reading files once further evidence no longer moves the picture.
- Yes: 0.60 or higherthenContinue
- Unsure: 0.30 up to 0.60thenContinue
- No: below 0.30thenStop
Accountable person, before anything is settled
Person decidesYes or no, with a probability
Before anything is reported as settled
Could this report be used to delay, decline, refer or report any claim or customer?
Sees only: The drafted report of surviving, broken and undecided statements
Why: Every report goes to the special investigations lead; the run takes no position on any file.
Accountable: The special investigations lead decides any action. No claim is delayed, declined or reported on the run's output alone.
- Yes: 0.10 or higherthenAsk a person
- Unsure: 0.02 up to 0.10thenAsk a person
- No: below 0.02thenAsk a person
The fleet: who does what
Model tiers by role, not brands: you choose the models. Strong reasoning models plan and reconcile, small fast models do the wide work, and the judge is a decision model from a different family, so it does not share the workers' blind spots.
Planner
A strong reasoning model breaks the hypothesis into specific, checkable statements about documents.
Decisions here:1. Scope check
Workers
Small fast workers in two teams: one cites documents supporting each statement, the other cites innocent explanations.
Designed for 10 to 200 agents, one worker task per one referred file's documents against the hypothesis. Each worker receives only its own unit.
Judge, from a different model family
A decision model from a different family decides whether each statement survives its objection on the documents.
Decisions here:2. Evidence check3. Evidence check
Reconciler
A strong reasoning model reports surviving, broken and undecided statements without naming any file as fraudulent.
Decisions here:4. Conflict check5. Another round?
Accountable person
The special investigations lead decides any action. No claim is delayed, declined or reported on the run's output alone.
Decisions here:6. Person decides
Checked before anything is accepted
- Every supporting point and every innocent explanation cites a document
- No inference is drawn from names, addresses, nationality or other personal characteristics
- The breaking team never sees the supporting team's reasoning
- Statements that rest on a single file are marked as weak
What comes back
- Statements of the hypothesis that survive, with sources
- Statements broken by an innocent explanation, with sources
- Undecided statements and what evidence would settle them
- Documents that were unreadable or missing
What to measure
- Share of surviving statements the investigator upholds
- Hypotheses narrowed or dropped before action
- Investigator hours per referral
- Cost per referred file read
Names of measures only. No result is claimed for this template.
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