Generate and view a claim's fraud score
Summarize
Summary of Generate and view a claim's fraud score
This feature enables claims adjusters, processors, and managers to generate and access detailed fraud scores for claim cases using Financial Services Operations Integration with FRISS. Fraud scores help assess the risk of fraud in a claim, aiding decision-making and fraud detection efforts. Administrators can customize fraud score pages to fit specific business line requirements.
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Generating and Accessing Fraud Scores
- Fraud scores can be generated or regenerated directly from claim case records or adjuster task records.
- The Fraud score tab on these records provides access to detailed fraud score information.
- This functionality is available only to authorized roles such as adjusters, processors, and claims managers.
Fraud Score Page Details
- Score Gauge: Visual indicator showing high, average, or low fraud risk based on configurable score ranges.
- Fraud Score: Overall numerical fraud risk score for the claim.
- Score Trend: Shows the change between current and previous fraud scores to track risk evolution.
- Service Provider: Identifies the fraud data analysis provider (e.g., FRISS) used for scoring.
- Screening Date: The date the claim was last screened for fraud.
- Contributing Indicators: Lists specific factors (e.g., Claim Date Check, Police Report) that influenced the fraud score, with scores and rationales for each indicator when FRISS is enabled.
- Score History Trend: A visual chart showing fraud score changes over time by screening date.
- Score History: Logs the number of fraud score API executions, including screening dates, rationale, and requestors, with filtering and refresh options.
Configuration
Administrators can customize fraud score displays and ranges using UI Builder to align with their line of business requirements, ensuring the fraud scoring aligns with organizational fraud detection strategies.
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.