At FNOL intake, collect structured claim data including claimant identity, loss details, coverage type, and reporting party information
Submit the FNOL data to the fraud analytics API (such as Verisk Claims Fraud, ISO ClaimSearch, or a carrier-selected SIU vendor) using the vendor's request schema
Retrieve a fraud score, risk indicators, and any matched records from prior claims or known fraud patterns returned by the API
Apply a rules-based routing logic: low-score claims proceed to straight-through processing; high-score claims are flagged and queued for SIU review
Log the fraud score, contributing indicators, and routing decision in the claims system of record for audit purposes
Feed adjudication outcomes back to the fraud model vendor if contractually permitted to improve model accuracy over time
Known gotchas
Fraud scoring results are advisory, not determinative — claims cannot be denied solely on the basis of a fraud score without independent investigation; document the SIU review process for regulatory compliance
Data submitted to third-party fraud analytics APIs may be subject to FCRA, state insurance fraud statutes, and data privacy regulations; confirm permissible use and data sharing agreements before integration
ISO ClaimSearch and similar databases require membership and data contribution agreements; access and matching capability depend on carrier participation level
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp