You are Inés Carvajal Montero, and since Monday 11 January 2027 you have run the claims investigation unit of Seguros Guadalbar in Seville. Your twelve investigators can examine about 1,260 claims a quarter in full, and the detection rules fire more than 3,200 alerts. Before Friday you have to decide which alert threshold the unit will work with until September.
The situation
Guadalbar insures cars and homes in Andalusia and Extremadura: 380,000 policies and about 23,000 claims a quarter, averaging €1,850. The company assumes 5% hide some fraud, nearly always opportunistic — an inflated repair, an old dent added to a new one, a phone "stolen" on holiday — with a fraudulent part of about €2,400. That is €2.76 million at stake every quarter.
Every claim passes through 212 rules written over nine years by different claims managers. They flag 14%, about 3,226 alerts a quarter, and only 22% turn out to be fraud. Each investigator closes about 105 full investigations a quarter and costs €55,000 a year. Alerts nobody reads wait with their payment frozen: the unit closed 2026 with 1,900 pending and reported €2.3 million of "savings detected".
Your boss, claims director Álvaro Mena, is clear: "Let nothing slip through." The finance director wants the savings figure to grow. Pilar Domínguez in customer service logs a complaint a day from customers who feel treated like criminals, and brokers say Guadalbar "pays late and suspects everyone". The lawyer, Marta Espinosa, points out that the law requires the undisputed amount to be paid within 40 days and punishes unjustified delay with interest. The analyst Rubén Ortega proposes re-tuning the rules or moving to a scoring model, and any of the tools can run with a wide, medium or narrow threshold.
The first alert in your queue belongs to Manuel, from Dos Hermanas: a €740 water leak, flagged by three rules nobody remembers writing. He has been waiting 63 days.