Score claims for fraud referral with a third-party fraud detection service

Steps

1. Select a fraud analytics vendor (e.g., Verisk CAIVRS, Shift Technology, or a carrier-specific model); obtain API credentials and the scoring endpoint URL from the vendor's integration guide.
2. At FNOL or claim update, assemble the fraud-scoring payload: claim type, loss date, loss description, claimant demographics, policy history, prior claims count, and any telematics or IoT signals available.
3. POST the payload to the vendor's scoring endpoint; receive a fraud score (numeric or tiered: low/medium/high) and a list of contributing indicators in the response.
4. Apply your carrier's referral threshold (consult your SIU guidelines for the exact score cutoff) to determine whether to auto-refer to the Special Investigations Unit or continue normal processing.
5. Write the fraud score, indicator list, and referral decision back to the claim record as structured metadata; trigger an SIU workflow task if the threshold is met.
6. Log all scoring calls with input hash, score, model version, and timestamp to satisfy regulatory audit requirements and support adverse-action documentation.