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The software sends client challenges to the machine, if the appropriate response is not received, it is flagged as a possible violation.
It uses heuristics to detect possible cheats when scanning the computers memory, an incident report is created whenever an anomaly is detected, which is then analyzed by Valve's engineers. The engineers inspect the code and may also run it on their own copies of the game. If the code is confirmed as a cheat, it is added to the database of cheat codes. New detections are also compared to previous detections in this database.
According to Steam's lead engineer John Cook, to stop the anti-cheat software itself from being exploited, "The software is constantly updated and sent down in small portions for the servers as needed, so hackers only get to see small portions of it running on any particular time. So while they may be able to work around pieces of it, they can never hack everything."