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Evaluate Claims Triage Classifier

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Problem

Context

BCG Digital Ventures has deployed a binary classifier in a claims triage workflow to identify insurance claims that should be escalated for manual fraud review. The current model is a gradient boosted tree classifier used in production scoring, but fraud operations reports that too many suspicious claims are still being approved automatically.

Current Performance

MetricValidation SetPrior ModelChange
Precision0.840.76+0.08
Recall0.580.71-0.13
F1-score0.690.73-0.04
ROC-AUC0.870.84+0.03
Review rate6.2%9.8%-3.6 pts
Fraud prevalence4.0%4.0%0.0 pts

Confusion Matrix at Current Threshold (0.70)

On a validation sample of 50,000 claims:

Predicted FraudPredicted Non-Fraud
Actual Fraud1,160840
Actual Non-Fraud22147,779

The Problem

Leadership wants to know whether this model is actually better than the prior version and whether the operating threshold is appropriate. The metrics appear mixed: precision and ROC-AUC improved, but recall and F1-score declined materially.

Requirements

  1. Interpret precision, recall, F1-score, and ROC-AUC using the numbers above.
  2. Explain what the confusion matrix says about model behavior at the current threshold.
  3. Diagnose why ROC-AUC can improve while recall worsens.
  4. Recommend whether to keep, retune, or replace the model.
  5. Propose how you would evaluate threshold changes under business constraints.

Constraints

  • Manual review team can handle at most 4,000 claims per day.
  • Missing a fraudulent claim costs about $1,200 on average.
  • Reviewing a legitimate claim costs about $18 in analyst time and customer friction.