Business Requirements Document System Architecture

Fraud Claims Investigation Platform

Solution Designer

Magnus Allen

Target Line of Business

Enterprise Fraud Services

Problem Space

Fragmented Investigation Lifecycle

Status

Architecture Spec

Dispute Case Lifecycle & Control Points

Phased process map — 14 steps across 4 phases · responsive

Phase 1

Intake & Classification

Start / Trigger

Member Dispute Received

Control Point

Intake Validation

Analyst Action

Claim Type & Eligibility

Control Point

Reg E Timing Checkpoint

→↓

Phase 2

Investigation

Documentation

Case Created / Data Captured

Analyst Action

Evidence & Documentation

Control Point

Risk Signal Review

Control Point

Provisional Credit Checkpoint

Documentation

Investigation Rationale

→↓

Phase 3

Decision & Communication

◇ Decision

Decisioning

Credit · Deny · Escalate

Handoff

Member Communication

Documentation

Closure / Status Update

→↓

Phase 4

Control Feedback

QA / Review

QA Review / Defect Capture

Feedback

Trend, SOP & Control Feedback

Start / Trigger Analyst Action Control Point ◇ Decision Documentation Cross-Functional Handoff QA / Review Feedback / Remediation

This map shows how a regulated dispute workflow can be structured so timing requirements, evidence capture, decision rationale, member communication, and QA feedback remain visible throughout the case lifecycle.

Operational Friction to Process Improvement Loop

Eight-stage feedback loop — recurring issues become documented improvements

Trigger

Recurring Case Friction

Analyst Action

Issue Theme Identified

Documentation

Root Cause Documented

Control Point

Requirement / Control Defined

Documentation

Workflow, SOP, or Job Aid Updated

Handoff

Training / QA Feedback Delivered

Metric / Monitor

Metric or Defect Trend Monitored

↩ Feedback Loop

Backlog / Remediation Loop

↩

Step 08 feeds back into step 01 when new friction surfaces — recurring issues drive continuous improvement rather than one-off fixes

Analyst Action Control Point Documentation Cross-Functional Handoff Feedback / Remediation

Recurring dispute issues should not be handled as isolated one-off defects. This loop shows how repeated friction becomes documented requirements, stronger controls, better guidance, and measurable process improvement.

Executive Summary

1 / 8

Four disconnected systems handle claims today: CRM, fraud platform, ledger, and spreadsheets — analysts manually transcribe data at every handoff
This platform unifies the full claim lifecycle into one structured workspace, routing each claim through the correct regulatory path, evidence standard, SLA timeline, and approval controls based on the facts of the claim
Automates risk signal generation, eliminates swivel-chair navigation, and enforces consistent process execution across all fraud and dispute types

The Problem

2 / 8

Phone agents manually transcribe intake into CRM — long hold queues during peak dispute volume
Analysts navigate 3–4 systems simultaneously with no unified case view; risk signals must be manually cross-referenced
Chargeback packages compiled manually and tracked in spreadsheets — missed filing windows create direct revenue leakage
Pattern detection relies on analyst memory rather than system-level alerting

Rules-Based Risk Signal Engine

3 / 8

Configurable rules engine auto-generates fraud risk signals at intake based on claim type and transaction data
Signals classified by severity (High / Medium / Low) and surfaced immediately in the analyst workspace
Pattern detection cross-references new claims against existing case activity — merchant-level and behavioral trends flagged automatically
Overrides require a reason code, written justification, and supervisor approval for high-severity signals — all retained in the audit log

Automated Chargeback Queue

5 / 8

Approved and eligible claims route automatically to a structured Chargeback Queue with no manual spreadsheet handoff
Each item tracks network, reason-code eligibility, last eligible file date, documentation checklist, pre-submission QA status, representment due date, and recovery outcome
Submission status tracked from Initiated to Pending Response to Won / Lost — missed-window exceptions logged for supervisor review

Provisional Credit & Reg E Workflow

6 / 8

Reg E SLA windows calculated from the case notice date and tracked at the case level: investigation deadline, provisional credit trigger, final determination, correction timing, and written notice requirements
Cases approaching or exceeding SLA thresholds auto-escalate to supervisor visibility and a compliance exception log
Denials or no-error determinations after provisional credit require documented reversal review, customer notice tracking, and closure controls before final disposition

The workflow tracks the initial investigation window, provisional credit requirement when the investigation extends, standard and exception extension windows, results notice timing, and correction timing when an error is confirmed. Intake date and notice date are captured at case creation. Oral vs. written notice type is tracked where applicable.

Milestone	Deadline
Initial investigation deadline	10 business days from notice
Provisional credit trigger	If investigation cannot be completed within 10 business days, credit when applicable to extend review
Extended investigation outer limit — standard EFT	45 calendar days, when provisional credit / extension requirements are met
Extended investigation outer limit — POS, foreign-initiated, or new-account transaction	90 calendar days, when applicable
Results notice to customer	3 business days after determination
Error correction after confirmed	1 business day
Timely notice checkpoint	Notice generally must be received no later than 60 days after the statement showing the error was sent

Customer Communication Controls

Customer communication tasks are generated from case status and regulatory path, including:

•Intake confirmation
•Document request tracking
•Provisional credit notice, where applicable
•Extension notice, where applicable
•Final determination notice
•Denial / no-error reason communication
•Reversal notice if provisional credit is revoked

Fraud Taxonomy & Investigation Routing

7 / 8

Six defined claim paths route through distinct evidence standards, SLA logic, chargeback eligibility, and approval controls
P2P/Zelle claims route through a dedicated Reg E coverage and scam-type analysis to distinguish unauthorized EFTs, fraudulently obtained access credentials, authorized push-payment scams, merchant disputes, and first-party fraud indicators
Wire / funds-transfer claims route to a separate funds-transfer review path, generally outside standard Reg E provisional-credit handling, with UCC Article 4A, bank-policy, and remittance-transfer applicability prompts where relevant
First-party fraud indicators, including friendly fraud and bust-out patterns, route to senior review before standard disposition

Claim type determines the workflow path, required evidence, SLA controls, provisional credit logic, chargeback eligibility, and approval authority. The platform forces a coverage and routing decision before the analyst can finalize disposition. The tables below reflect synthetic workflow design examples, not legal conclusions.

Fraud Type	Channel	Key Investigation Signal
Card Not Present (CNP)	Online / Phone	Device mismatch, IP geolocation, velocity
Counterfeit / Card Present	POS / ATM	Skimming indicators, PIN compromise
Account Takeover (ATO)	Any	Credential changes, new device, address update
Unauthorized ACH	ACH Network	Originator ID, NACHA return reason, credential exposure
Wire / Funds Transfer Claim	Fedwire / wire-transfer rail / bank funds-transfer system	Beneficiary analysis, authorization method, call-back/control review, social engineering indicators — routes to separate funds-transfer review path with UCC Article 4A, bank-policy, and remittance-transfer applicability prompts where relevant
P2P / Zelle	P2P Network	Payee recognition, transfer velocity, scam indicators — routes through dedicated Reg E coverage and scam-type analysis

Routing Decision Matrix

Synthetic workflow examples showing how claim facts drive routing, regulatory path, and approval controls.

Claim Path	Reg / Policy Review	Provisional Credit	Chargeback Eligible	Approval Level
Unauthorized debit card EFT	Reg E error resolution	Yes, when applicable	Often yes	Analyst / Supervisor
P2P/Zelle — unauthorized access	Reg E coverage analysis	Yes, when applicable	Network / platform dependent	Analyst / Supervisor
APP scam / deception-authorized	Bank policy; Reg E coverage check	Depends on coverage	Usually limited	Senior review — high exposure
Wire transfer claim	Funds-transfer review; UCC 4A / bank policy; remittance-transfer applicability prompts where relevant	Generally outside standard Reg E PC handling	No card chargeback path	Supervisor / Senior review
Merchant dispute	Network rules / merchant dispute path	Depends on product / reg path	Yes, when eligible	Analyst / QA pre-submit
First-party / friendly fraud	Fraud risk review / senior review	Hold / review per policy	Requires senior validation	Senior Analyst / Supervisor

Compliance & Governance

8 / 8

SLA enforcement is system-driven through live countdowns, auto-escalation, compliance exception logging, and supervisor visibility
All platform actions generate immutable audit records — timestamp, user, role, action, status change, override reason, and disposition; intake locks after submission with corrections handled through documented amendments
Role-based access separates casework, approval, QA, and system configuration across five access tiers

💻 Launch Investigation Hub Sandbox

What This Demonstrates

Regulated workflow analysis, dispute operations judgment, control-gap identification, documentation discipline, and the ability to turn frontline friction into clearer operational processes.

Dispute Case Lifecycle & Control Points

Operational Friction to Process Improvement Loop

Executive Summary

The Problem

Rules-Based Risk Signal Engine

Unified Investigation Workspace

Automated Chargeback Queue

Provisional Credit & Reg E Workflow

Fraud Taxonomy & Investigation Routing

Compliance & Governance