Generate and view a claim's fraud score
Summarize
Summary of Generate and view a claim's fraud score
This feature enables claims managers, adjusters, and processors to generate and view a claim's fraud score, providing insights into the potential fraud risk associated with a claim. It leverages Financial Services Operations Integration with FRISS and is accessible from claim case records and adjuster task records.
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Key Features
- Fraud Score Tab: Access the fraud score page directly from the claim case or adjuster task.
- Score Generation: Generate or regenerate the fraud score using the 'Regenerate fraud score' option.
- Score Details: View a score gauge indicating high, average, or low risk, along with the overall fraud score number.
- Score Trend: Analyze the trend showing differences between the current and previous scores.
- Indicators: Review indicators contributing to the fraud score, including rationale for each indicator when FRISS is enabled.
- Score History: Access a visual chart of score history over time, detailing screening dates and requestor information.
Key Outcomes
By utilizing the fraud score feature, customers can effectively assess and manage fraud risk in commercial claims. The ability to configure fraud score ranges through the UI Builder allows for customization to meet specific business requirements. This proactive approach helps in making informed decisions on claims management.
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.