The integration connects at two primary layers within the Sapiens ecosystem: the claims intake/processing engine and the dedicated fraud management module. At FNOL, an AI service is triggered via API to score the initial loss report in real-time, analyzing narrative text, claimant history, and linked policy data for patterns indicative of soft fraud or buildup. This score is written back to the claim file as a custom field, allowing Sapiens' native rules engine to route high-risk claims automatically for enhanced validation or special investigation unit (SIU) assignment. For ongoing monitoring, a separate batch process analyzes newly linked entities (repair shops, medical providers, witnesses) across the entire book of business, flagging networks and outliers that may not trigger traditional rule-based alerts.




