Build a claims fraud scoring pipeline using a third-party fraud analytics API integrated into the FNOL workflow

Steps

1. At FNOL submission, extract the key fraud indicator fields: claimant identity, loss date, loss type, reported circumstances, involved parties, and policy information
2. Submit the claim data to a fraud analytics API (e.g., Verisk Insurance Services, LexisNexis Attract, or Shift Technology) for real-time fraud score generation
3. Parse the fraud score response: overall score, contributing factor flags (staged accident indicators, prior fraud flags, address inconsistencies, social network links), and recommended action
4. Route high-score claims to a Special Investigations Unit (SIU) queue with the fraud indicators pre-populated for investigator review
5. For borderline scores, apply secondary validation rules (e.g., ISO ClaimSearch prior claims check) before making a routing decision
6. Log all fraud scores and routing decisions with the claim record and track SIU referral outcomes to calibrate score thresholds over time