Skip to main content

Advanced Configuration

Fraud Detection Engine​

The Claims Processor includes a sophisticated fraud detection engine that analyzes claims in real-time.

Configuration​

builder.Services.AddPrimusClaimsProcessor(options =>
{
    options.EnableFraudDetection = true;
    options.FraudDetectionRules = new List<FraudRule>
    {
        FraudRule.HighValueClaim(threshold: 50000),
        FraudRule.RapidSubmission(hoursSinceLoss: 2),
        FraudRule.GeographicMismatch(),
        FraudRule.FrequencyCheck(claimsInPastYear: 3)
    };
});

Custom Fraud Rules​

You can implement custom fraud detection logic by implementing IFraudCheck.

public class WeatherCheck : IFraudCheck
{
    public async Task<FraudResult> CheckAsync(Claim claim)
    {
        var weather = await _weatherService.GetHistoryAsync(claim.LossDetails.Location, claim.DateOfLoss);
        
        if (claim.LossDetails.Cause == "Hail" && !weather.HasHail)
        {
            return FraudResult.Flag("Weather mismatch: No hail reported at this location/time");
        }
        
        return FraudResult.Pass();
    }
}

Document Processing (OCR)​

Automate data extraction from uploaded documents using Azure AI Document Intelligence or AWS Textract.

Setup​

{
  "PrimusClaimsProcessor": {
    "EnableOcrProcessing": true,
    "OcrProvider": "Azure",
    "AzureDocumentIntelligence": {
      "Endpoint": "https://your-resource.cognitiveservices.azure.com/",
      "Key": "your-api-key"
    }
  }
}

Supported Documents​

  • FNOL Forms: Automap to ClaimSubmission fields
  • Police Reports: Extract incident details and parties involved
  • Medical Bills: Line item extraction for injury claims
  • Repair Estimates: Auto-compare against reserves

Adjudication Workflow​

Configure the adjudication chain of command and authority limits.

Authority Levels​

options.Adjudication = new AdjudicationConfig
{
    Levels = new[]
    {
        new AuthorityLevel { Role = "JrAdjuster", MaxLimit = 5000 },
        new AuthorityLevel { Role = "SrAdjuster", MaxLimit = 25000 },
        new AuthorityLevel { Role = "Manager", MaxLimit = 100000 },
        new AuthorityLevel { Role = "VP", MaxLimit = decimal.MaxValue }
    }
};

Workflow State Machine​

The claim status transitions are managed by a configurable state machine.

stateDiagram-v2
    [*] --> Draft
    Draft --> Submitted
    Submitted --> Validated
    Validated --> Investigation : Low Confidence
    Validated --> Adjudication : High Confidence
    Investigation --> Adjudication
    Adjudication --> Approved
    Adjudication --> Denied
    Approved --> Settled
    Settled --> [*]

Integration Patterns​

Guidewire ClaimCenter​

Sync claims bi-directionally with Guidewire.

builder.Services.AddPrimusClaimsProcessor(options =>
{
    options.Provider = ClaimsProvider.Guidewire;
    options.Guidewire = new GuidewireOptions
    {
        BaseUrl = "https://cc-policy-center.example.com",
        Authentication = GuidewireAuth.OAuth2
    };
});

Custom Event Webhooks​

Broadcast claim events to standard HTTP webhooks.

options.Webhooks.Add(new WebhookSubscription
{
    Url = "https://finance-system.internal/api/hooks/payment-approved",
    Events = new[] { "ClaimStatusChanged", "PaymentIssued" },
    Headers = new Dictionary<string, string> { { "X-API-Key", "secret" } }
});