58K E-Commerce Return Claims Reviewed with 95% QA Accuracy
58K
Claims Reviewed254
Fake Police Reports>90%
Two-Day Resolution Rate<3%
QA Findings Rate Achieved
The Challenge
Fraudulent Claims, Processing Inefficiencies, and Poor CX Impact
The client faced increasing pressure from rising fraudulent claims and inefficiencies in claims processing, leading to financial losses and a decline in customer satisfaction. In short, the key challenges were:
- Incorrect/ Fraudulent claims submitted by Customers and eventually processed and refunded, resulting in a loss to the company.
- Customer frustration and disputes due to inaccurate, untimely processing of claims.
- Severe impact on customer experience because of non-proactive resolution
Sutherland Solution
Domain Expertise, Analytics, and Structured Validation to Curb Fraud
Sutherland implemented a targeted approach combining domain expertise, data-driven insights, and robust validation frameworks to improve fraud detection and streamline claims processing.
Setup a Domain Team
- Deployed team with deep domain expertise as a fraud SME, agents who have handled customer disputes, and a team with an analytical mindset.
Analytical Insights
- Analyzed key drivers of claims rejection and root causes
- Captured structured reason codes to uncover patterns, including repeated illegitimate claims by the same customers
Process Validations
- Created a compliance checklist for claim validation
- A structured approach to reviewing and validating supporting documents to ensure authenticity and detect fraud.
The Outcome
A More Accurate, Scalable, and Customer-Focused Fraud Resolution Operation
Since Sutherland took over the fraud and scam line of business, service performance has improved significantly. The team established a noise-free environment with zero escalations, while delivering measurable gains in the accuracy and timeliness of fraud resolution. Missed scam tickets are now being fully identified, and the backlog has been eliminated. In parallel, collaboration with the CX and frontline teams has improved significantly, enabling a stronger customer focus and more proactive issue resolution.
