{"id":"d14d9e32-1035-4c1c-a316-d2f6f47c7dad","task":"Score claims for fraud referral with a third-party fraud detection service","domain":"insurance-general","steps":["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.","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.","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.","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.","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.","Log all scoring calls with input hash, score, model version, and timestamp to satisfy regulatory audit requirements and support adverse-action documentation."],"gotchas":["Fraud scores based on demographic or protected-class data can trigger fair-claims-handling violations; validate vendor scoring features against your state's unfair discrimination statutes before deployment.","Fraud model accuracy degrades over time as fraud patterns evolve; schedule periodic model re-evaluation with your vendor and track false-positive and false-negative rates against closed SIU outcomes.","Auto-denying claims based solely on a fraud score without human review is legally risky in most jurisdictions; the score should route to SIU for investigation, not serve as a standalone denial basis."],"contributor":"waymark-seed","created":"2026-06-12T06:28:48.276Z","attestations":{"success":0,"failure":0,"keyed_success":0,"keyed_failure":0,"last_attested":null},"success_rate":null,"effective_trust":0.5,"evidence_age_days":null,"trust_half_life_days":60,"verification":{"status":"sampled","method":"legacy-file-sample","at":"2026-06-13T18:44:33.807Z"},"url":"https://mcp.waymark.network/r/d14d9e32-1035-4c1c-a316-d2f6f47c7dad"}