Fraud Prevention Entity Search

Overview

This function allows a carrier to determine if an applicant, driver, operator or VIN has been previously associated with any policy or claim. Also known as "Black Listing," carriers have different reasons for wanting to know if an applicant, driver, operator or vehicle has previously been insured or made a claim under a different policy. Some of those reasons might be:

Preventing agents or employees from binding coverage on certain individuals.
Determining if the same claimant is listed on multiple claims, or
Monitoring other fraudulent activity.

When an individual is added to Restricted Entity List Management (Diamond Administration / Fraud Prevention) AND a Search Type Configuration has been established as "Blacklist" in Company Configuration Tool / Fraud Prevention / Search Configuration, a policy will either stop from being issued or a warning will be displayed (depending on the "Action Type") selected there.

Step 1: System Editor - Policy Folder

Set the "Fraud Prevention" system setting to "True." This enables the Fraud Prevention functionality.

Step 2: Administration: Users and Workflow Queues / Users

Diamond Administration Group

Users must have the following authorities in the Diamond Administration group:

Workflow Authority	Impact on User
Fraud Prevention Restricted Entity List Access	Allows users to access the Fraud Prevention Blacklist.
Fraud Prevention Restricted Entity List Management	Allows users to modify the Fraud Prevention Blacklist (Add / Edit / Delete).

Company Configuration Group

Workflow Authority	Impact on User
Fraud Configuration Management	Allows users to modify the Fraud Prevention Configurations.

Policy Processing Group

Workflow Authority	Impact on User
Fraud Prevention Search Log Approval	Allows users to approve the Fraud Prevention Search Log on the Policy Information screen.

Step 3: Company Configuration Tool / Fraud Prevention

Search configurations can be set up by Entity or VIN.

Entity Search Configuration

From the Entity Search Configurations toolbar, click Add to display the Add Fraud Prevention Entity Search Configuration screen.

Search Type: Select Blacklist or Name. If "Name" is selected, this search only includes the specific name address source ids (e.g., Client 1, Client 2, Policyholder 1, Policyholder 2, Driver, etc.). If "Blacklist" is chosen, it only searches the Blacklist names.
Trigger Type: Choose Submit, Promote or Issue.
Command Timeout: Defaults to 120 but can be changed.
Active: Defaults with a check; the search remains valid in your system. To deactivate the search, click in the field and remove the check.
Include Driver License Number / Include Tax Number: Place a check in each box to further define your search criteria.
Transaction Types: Opposite each transaction the Search Type is being set up for, place a check opposite the transaction type.

You can further define your search configuration by selecting Add from the Results Configuration Toolbar below. Items set up here are events that happen in Policy Processing when the Search Configuration criteria is met.

User Category: Choose Employee, Client, Agency or Guest.
Action Type: Select either "Stop" or "Warn." Stop prevents an action. For example, if "Stop" is selected and the "Trigger Type" is submit, the stop does not allow the submission to complete. If trigger type is "Promote," stop does not allow a quote to be promoted to a pending policy. "Warn" returns a warning message in all instances; does not stop issuance.
Create a System Generated Note: Place a check in this field to add a system-generated note to the policy when search results are found. This option does not apply to the "Submit" trigger type.
Note Type: Choose from the types of notes available in the combo box.
Message: Enter a brief narrative indicating the reason for the reason the policy is being stopped or a warning is displayed. Depending on the Trigger Type selected, this message is displayed on the UI.
List Items in the Notification Message: Checking this option means that the entities (e.g., Names) that match are listed in the message returned to the user. Not checking this option means that the user will be notified that matches were found but the specific names will not be returned in the message.
Transfer to the Help Workflow Queue for the Associated Agency: Checking this means that the policy will automatically be transferred to the agency help queue when matches are found. The user is notified of the transfer.
Click Save when finished.

Click Save again to return to the Search Configurations List View.

VIN Search Configuration

From the VIN Search Configuration, click Add to display the Add Fraud Prevention VIN Search Configuration screen.

Trigger Type: Choose Submit, Promote or Issue.
Command Timeout: Defaults to 120 but can be changed.
History Days: This is the number of days to subtract from the current system date for cancelled and expired policies.
Quote Days: This is the number of days to subtract from the current system date for new business quotes / policies.
Body Types: Opposite each type of vehicle the Search Type is being set up for, place a check opposite it.

Again, you can further define your search configuration by selecting Add from the Results Configuration Toolbar below. Items set up here are events that happen in Policy Processing when the Search Configuration criteria is met.

User Category: Choose Employee, Client, Agency or Guest.
Action Type: Select either "Stop" or "Warn." Stop prevents the issuance. "Warn" returns a warning message; does not stop issuance.
Create a System Generated Note: Place a check in this field to send a note to either the user or workflow queue.
Note Type: Choose from the types of notes available in the combo box.
Message: Enter a brief narrative indicating the reason for the reason the policy is being stopped or a warning is displayed. Depending on the Trigger Type selected, this message is displayed on the UI.
List Items in the Notification Message: Checking this option means that the entities (e.g., Names) that match are listed in the message returned to the user. Not checking this option means that the user will be notified that matches were found but the specific names will not be returned in the message.
Transfer to the Help Workflow Queue for the Associated Agency: Checking this means that the policy will automatically be transferred to the agency help queue when matches are found. The user is notified of the transfer.
Click Save when finished.

Click Save again to return to the Search Configurations List View.

Step 4: Diamond Administration / Fraud Prevention / Restricted Entity List Management

This allows users to manually add individuals or entities to an "uninsurable" list. To add an individual:

Click Add.
Enter the first name / last name (and middle name, if available), SSN and Driver's License Number.
Reason: Select from the combo box.
Remarks: Enter any narrative describing why the person is being placed on the black list.
Click Save.

Step 5: Quotes / New Business Policy (Example)

Let's say a potential client has been entered in Restricted Entity List Management. The Search Configuration is then set up as follows:

Entity Configuration	Results Configuration
Search Type = Blacklist	User Category = Employee
Trigger Type = Issue	Action Type = Stop
Transaction Type = New Business	Message = "Claim activity with current carrier."

A new business policy is entered and rated. On Issue, the policy is stopped from issuing and a validation is presented: "Claim activity with current carrier."

Step 6: Override Black Listing (Optional)

Providing a user has the authority, they can override the Black List on the Policy Information screen.

Fraud Prevention Search Log Link: Select
Click the Approve link in the Grid View.
Confirm the approval.
Re-rate and issue the policy.