Guest: Dajana Gajic-Fisic
Today I’m digging into refund claims fraud, which is one of those problems a lot of online retailers were feeling long before they had the right language for it. And honestly, that is part of what made it so difficult. Teams could see the symptoms. Claims were rising. Certain customer stories were repeating. Losses were stacking up. But it was not always obvious what bucket the issue belonged in, or how to explain it clearly enough to get the right attention internally.
That is exactly why I wanted to have this conversation with Dajana Gajic-Fisic, Head of eCommerce Risk Management at Finish Line. Over the last few years, both of us have spent a lot of time understanding this issue more deeply, and in part one of this discussion, we focus on the foundation. What refund claims fraud actually is. What it is not. How it differs from policy abuse or return fraud. And why retailers have to get that distinction right if they want a real chance at reducing losses.
Because at first glance, all customer claims can blur together.
But when you look closer, intent matters. Method matters. Process vulnerabilities matter. And if a company treats legitimate customer issues, policy abuse, and refund claims fraud like they are all the same thing, it will end up with the wrong strategy for all three.
This is where things start to get interesting.
Because once a retailer begins to understand the size of the problem, identify the gaps being exploited, and separate real customer pain from intentional deception, the conversation gets much more useful. Not easier, exactly. But clearer. And that is the first step.
Here is what that means in practice:
- Refund claims fraud is not the same thing as policy abuse or return fraud, even if the losses can look similar on the surface
- Retailers need better fraud gap analysis to understand which parts of the claims process are actually being exploited
- Leadership fraud reporting gets much stronger when teams can clearly quantify retailer fraud losses tied to refund claims fraud
- Identifying customer claims accurately is essential if companies want to protect good customers while reducing abuse
What you’ll hear in this episode:
- How Dajana and I define refund claims fraud and why that definition matters so much for retailers
- What makes refund fraud vs policy abuse an important distinction instead of just a wording preference
- How return fraud differences show up when teams start breaking claims down by intent and method
- Why COVID accelerated some of the conditions that made refund claims fraud harder to ignore
- How merchant fraud collaboration helped a group of retailers share attack methods and learn from each other over several years
You should listen to this episode if you:
- Work in ecommerce, fraud, operations, or customer experience and need a clearer foundation for understanding refund claims fraud
- Want better refund fraud detection without mistakenly treating every customer issue like intentional fraud
- Are trying to explain retailer fraud losses and process vulnerabilities to leadership in a more credible way
- Need stronger ecommerce risk strategy around claims fraud trends and online retail fraud
- Care about retail fraud prevention and want to separate legitimate customer claims from deliberate exploitation
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Episode notes & key takeaways
This conversation is really about getting the definition right before trying to fix the problem. I walk through this with Dajana because too many retailers were seeing the symptoms of refund claims fraud without having a clean way to separate it from policy abuse, return fraud, or legitimate customer friction. Once that starts to get clearer, the path to measurement, leadership alignment, and better prevention gets a whole lot stronger.
Why refund claims fraud needs to be defined clearly first
Let’s break this down.
One of the biggest mistakes retailers can make is trying to solve refund claims fraud before they have actually defined what they are solving. That sounds basic. It is not. A lot of companies know claims are rising, know losses are happening, and know something is off. But if they have not separated refund claims fraud from policy abuse, return fraud, and legitimate claims, the response usually gets messy pretty quickly.
That is a problem.
Because once everything is treated as one giant claims issue, the business starts applying the same lens to very different behaviors. A legitimate customer who had a real fulfillment issue is not the same as someone exploiting policy gaps casually. And neither is the same as someone intentionally using deceptive tactics to get money or merchandise they are not entitled to. Those differences matter operationally, financially, and strategically.
This is exactly why Dajana and I spend so much time in this episode on what refund claims fraud is and what it is not. If the definition is fuzzy, the strategy will be too.
A few practical takeaways:
- Refund claims fraud should be defined by intentional deceptive claims, not just elevated refund volume
- Refund fraud vs policy abuse matters because the right solution depends on the real intent behind the claim
- Return fraud differences matter when teams are trying to assign ownership and response strategy correctly
- Retail fraud prevention gets stronger when companies stop treating every claim problem as the same category
Why the symptoms showed up before the industry had the language
Here’s what’s actually happening.
A lot of retailers felt this problem before they could really describe it. Claims were increasing. Certain categories of issues seemed to repeat. Some businesses saw patterns around non-delivery claims, empty box stories, or missing item complaints. But because the claims process often touches multiple teams, the signals were fragmented. Support might see one part. Operations might see another. Fraud might only see the financial side later.
That usually does not end well.
Because if the signals are scattered, the company can spend a long time reacting to symptoms without understanding the structure underneath them. That is why this issue stayed harder to isolate for a while. Teams were seeing pain, but not always seeing the same pain in the same place at the same time.
And that matters.
Because once businesses started comparing notes more deliberately, especially during and after the shifts created by COVID, it became much easier to see that this was not just random customer friction or a few isolated bad actors. There were repeatable claims fraud trends showing up across retailers.
What good teams should pay attention to:
- Refund claims fraud often becomes visible through symptoms before it is clearly categorized
- Online retail fraud can hide inside customer service and operational workflows long before fraud teams fully isolate it
- Covid refund fraud pressures made it easier to see how process changes and claim volume could be exploited
- Refund fraud detection improves when companies connect signals across support, operations, fraud, and fulfillment
Why refund fraud vs policy abuse is such an important distinction
This is where a lot of teams get tripped up.
Policy abuse and refund claims fraud can both create losses. They can both frustrate retailers. They can both damage trust in the claims process. But they are not interchangeable. And if a company blurs them together, it tends to build blunt responses that do not actually solve much.
Right.
Policy abuse often sits in the space where a customer is taking advantage of flexibility or leniency in a way the business did not intend. Refund claims fraud is more directly about deceptive claims. The difference may seem subtle to people outside the space. It is not subtle when you are trying to build the right controls.
Because the moment intent changes, the solution changes too.
A retailer trying to reduce ecommerce refund abuse through tighter policy language may still miss deliberate claims fraud if the process vulnerabilities remain wide open. On the other hand, a team trying to investigate every edge-case customer complaint like organized fraud can create unnecessary friction and damage good customer relationships.
That is exactly why this distinction deserves more respect than it usually gets:
- Refund fraud vs policy abuse affects how companies investigate, escalate, and design process controls
- Identifying customer claims accurately helps protect legitimate customers while reducing avoidable loss
- Ecommerce refund abuse and refund claims fraud may overlap operationally, but they are not the same strategic problem
- Retailers need better classification if they want leadership fraud reporting to reflect reality
How retailers should start measuring the real size of the problem
This is one of the most practical parts of the episode.
Once a retailer understands that refund claims fraud may be part of what it is seeing, the next question is obvious. How big is the problem for us, really? And that is where a lot of companies need more structure. Because if the losses are spread across teams, systems, and claim types, it is very easy to underestimate the impact.
That is where fraud gap analysis becomes essential.
The goal is not just to count claims. It is to understand where the process is vulnerable, which claims are legitimate, which ones are suspicious, which issues are avoidable operational failures, and where intentional deception is showing up most clearly. That is how companies start turning a vague pain point into something measurable enough to take to leadership.
And that matters.
Because leadership fraud reporting works much better when teams can show not only that losses are rising, but also how the exploitation is happening and where the process needs attention. Without that, it is much harder to get alignment, resources, or urgency.
A few things worth watching:
- Refund claims fraud measurement should include process vulnerability, not just claim totals
- Fraud gap analysis helps identify where losses are tied to deception versus internal friction
- Leadership fraud reporting is more effective when the business sees both financial impact and process weakness
- Ecommerce risk strategy improves when teams move from anecdotal concern to measurable patterns
Why retailer collaboration changed the conversation
Honestly, this is one of the strongest parts of the story.
Dajana talks about how a group of roughly 40 retailers worked together over more than three years to share what they were seeing, compare methods, and learn from one another. And that kind of merchant fraud collaboration matters a lot more than people sometimes realize.
Because a problem like refund claims fraud can be incredibly hard to isolate inside one company alone.
But once multiple retailers start seeing similar tactics, similar process exploitation, and similar attack methods, the pattern becomes much harder to dismiss. That is exactly how industries start moving from “something weird is happening here” to “this is a real, growing fraud issue that needs a more serious response.”
We have seen this playbook before in other fraud categories.
And it holds up here too. Collaboration does not solve the problem by itself. But it accelerates understanding. It helps teams validate what they are seeing. It helps newer teams avoid reinventing the wheel. And it gives retailers a better shot at responding before the losses grow even further.
The big takeaway from this episode is pretty straightforward. Refund claims fraud cannot be addressed well until retailers understand what it actually is, what it is not, and where it sits apart from policy abuse, return fraud, and legitimate customer claims. Once that definition gets clearer, the rest of the work becomes much more actionable, from refund fraud detection and fraud gap analysis to leadership reporting and stronger retail fraud prevention. That is the part that holds up.
