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, providing insights into potential fraud risks. The integration with Financial Services Operations and FRISS enables detailed assessments directly from claim case and adjuster task records.
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Key Features
- Fraud Score Generation: Users can generate or regenerate fraud scores from claim records or adjuster tasks.
- Fraud Score Page: Access comprehensive details including risk levels, score trends, and contributing indicators on the designated fraud score tab.
- Customizable Scoring: Admins can tailor fraud score ranges to align with specific business requirements using UI Builder.
- Indicator Details: Displays factors influencing the fraud score, such as Claim Date Check and Police report, alongside their respective rationales.
- Score History: Provides historical trends and execution counts for fraud score assessments, allowing users to filter and refresh data as needed.
Key Outcomes
By utilizing this feature, ServiceNow customers can effectively assess and monitor fraud risk in claims, enabling informed decision-making and enhanced fraud detection capabilities. The insights gained can help in mitigating potential losses and ensuring compliance with industry standards.
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.