ISO Introduces Claims-Scoring System to Expedite Claims Processing, Fraud Identification

July 14, 2003

Insurance Services Office, Inc. (ISO) has introduced ClaimDirectorSM — a fraud-fighting resource that analyzes claim attributes and industrywide claims histories to produce a claims-handling score.

The new resource from the ISO ClaimSearch’ suite of claims-information products will streamline the claims-handling workflow, assist with loss assignment based on claim characteristics, enable adjusters to expedite payment of legitimate claims and reportedly improve the quality of referrals to the special investigations unit (SIU).

ClaimDirector is an expert, rules-based claims-scoring system for claims handling — not an underwriting tool. The service assigns each claim a numerical score, ranging between 0 and 999. A high score means the presence of characteristics indicating the possibility of fraud.

Designed by ISO experts, industry claims and antifraud personnel, and National Insurance Crime Bureau (NICB) fraud investigators, ClaimDirector can help companies enhance productivity, improve fraud detection, reduce loss-adjustment expenses and increase profitability.

The first release of ClaimDirector scores personal auto liability claims. In the coming months, ClaimDirector will add scoring of other types of personal and commercial claims, including homeowners, workers compensation, general liability, commercial auto liability and personal auto physical damage. When a claim is submitted to ISO ClaimSearch, ClaimDirector returns a full cross-line claims history on the insured (individual or business), claimant, property and vehicle.
ClaimDirector scores each claim at the first notice of loss — and throughout the life of the claim.

As updated information on the claim is submitted to the ISO ClaimSearch database, insurers receive the most current score. ClaimDirector analyzes the attributes of the claim and information from any matching claims in the database and compares those attributes against proven fraud indicators appropriate for the claim.

ClaimDirector is a flexible tool delivered with sets of default values for many elements, including weights applied to fraud indicators and loss-assignment and claims-handling characteristics. Companies can tailor ClaimDirector to customize its scoring to suit the needs of the organization.

ClaimDirector can also flag claims according to a variety of data sources and advisory lists, including a list of case principals from NICB investigations.

Claim departments can also establish an e-mail system to notify SIU or other designated claim professionals of claims that require immediate attention.

ClaimDirector will issue detailed reports on scoring activity and score levels by the office submitting the claim. This allows authorized claims-management personnel to view claim summary reports by group, company and office to evaluate the overall company experience, including trending information for advanced analysis.

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