Interview Guides
You are reviewing quarter-end results for a mid-sized insurance business that processes a high volume of customer submissions. During close, you find both confirmed fraud losses and false information submissions that were denied before payment. Your CFO wants to know the earnings impact this quarter and whether the current review threshold is too strict or too loose. Assume U.S. GAAP and USD.
| Metric | Amount |
|---|---|
| Gross submissions processed | 52,000 |
| Average submission value | 180 |
| Confirmed fraud rate on processed submissions | 1.8% |
| Recovery rate on confirmed fraud losses | 25% |
| False information submissions denied before payment | 2,400 |
| Average manual review cost per denied submission | 12 |
| Current manual review threshold | 8% |
| Expected false-positive rate at current threshold | 4.5% |
How would you quantify the quarter’s fraud-related earnings impact and evaluate whether the current review threshold is too strict or too loose? What would you recommend changing, if anything, based on the numbers?
