Generate and view a claim's fraud score
Summarize
Summary of Generate and View a Claim's Fraud Score
This feature allows claims managers, adjusters, and processors to generate and view a fraud score for claims using the Financial Services Operations Integration with FRISS. It provides detailed insights into a claim's fraud risk, helping to assess and mitigate potential fraudulent activities.
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Key Features
- Fraud Score Generation: Users can generate or regenerate a fraud score from claim case records and adjuster task records by accessing the Fraud score tab.
- Fraud Score Page: The fraud score page displays comprehensive details including the overall fraud score, risk level, and indicators contributing to the score.
- Score Trend: Users can view score trends, comparing current scores with previous ones, and visualize score history over time.
- Customization: Admins can create a customized scoring page by configuring fraud score ranges tailored to their specific business needs.
Key Outcomes
By utilizing this feature, users can effectively assess the fraud risk associated with claims, enabling informed decision-making. The insights provided through the fraud score details and history empower teams to take proactive measures against potential fraud, thereby enhancing operational efficiency and safeguarding resources.
Generate a fraud score, and view the fraud score page to get detailed insight into a claim's fraud score and history.
Generating and accessing fraud score details
If you're a claims manager, adjuster, or processor for a company, you can generate and access claim fraud score details by using Financial Services Operations Integration with FRISS. This option is only available on claim case records and adjuster task records.
- Select the Fraud score tab to view the fraud score page.
- Select Regenerate fraud score to generate or regenerate a fraud score.
Fraud score page
In the claim or from an adjuster task, you can see information about fraud scores on the Fraud score tab.
The following example shows the fraud score page for the Personal Lines Claims application with score details.
Fraud score page details
- Score gauge
- Shows a high, average, or low risk score based on the passed claim data. You can configure the display by defining the ranges for high, average, or low scores. For more information on how to configure the ranges, see Configure the fraud score ranges with UI Builder.
- Fraud score
- Overall fraud score number.
- Score trend
- Displays the difference between the current and the previous score.
- Service provider
- Shows the name of the fraud data analysis service provider.
- Screening date
- Refers to the date that a claim was screened for fraud detection.
- Indicators contributing to the fraud score
- If FRISS is enabled, displays a list of indicators such as Claim Date Check and Police report that factor into the fraud score, with accompanying scores and rationales for why each score was specified for the indicator. For more information about FRISS, see Financial Services Operations Integration with FRISS.
- Score history trend
- Displays a visual chart of score history over time by screening date.
- Score history
- Displays the number of times that the API is executed for the claim case. Lists scores with screening dates, rationale for screening requests, and screening requestors. You can select to filter and refresh history on demand.