Risk Response: Your Guide to Smarter, Faster Claim Decisions

May 12, 2026 / 3 min read

With the growing pressure on insurance companies to make faster decisions without impacting overall accuracy, the industry needs a way to quickly determine risk level on claims to help identify those that can be fast tracked and those that need to be slowed down for investigation. Risk Response with ClaimSearch can help!

risk-level-dashboard

Risk Response is a risk summary sent back to carriers to support informed decision making. The Response includes identifying data (i.e. claim number) for each claim, a risk indicator (low, medium, high) and claim alert information. Claim alerts notify carriers of potentially suspicious activity or compliance-related concerns. Risk Response is available within an insurance company’s ClaimSearch subscription and allows for delivery of risk insights related to that member company’s claims separate from the match reports.

The member company can use Risk Response data to generate notifications for claim handlers within their respective claim system to assist in their decision making. Notifications are designed to assist claim handlers with improved workflows and increased speed of decisions. A claim handler can quickly see the “Low Risk” claims that are eligible for fast-track handling, medium risk claims that may need a quick review, and high-risk claims that need a full slow down and potential SIU investigation. A Risk Response is generated every time a company submits a new claim or passes an update or replacement for an existing claim to ClaimSearch.

Let’s look at a specific example. A carrier submits a new auto claim, Risk Response immediately evaluates the data and returns a “High Risk” indicator along with an alert noting prior loss activity involving the same claimant. With Risk Response, the information can feed directly into the adjuster’s claim file, helping them identify the elevated risk early, pause fast‑tracking, and escalate the file to SIU for further review.

In contrast, another claim submitted the same day might return a “Low Risk” indicator with no alerts, allowing the adjuster to confidently move that claim through the fast‑track process. As the company submits updates or replacements to ClaimSearch, they will receive a response with each submission.

Companies who subscribe to Verisk’s Claim Scoring product can also take advantage of Risk Response, and their response data will include the claim scoring information in place of claim alerts. A claim scoring customer will still see claim alert information related to compliance issues. Risk Response with Claim Scoring allows for further customization in that customers have the ability to choose which claim scoring rules are a part of Risk Response.

Additionally, a company could choose to use Smart Risk Response instead of Standard Risk Response. Smart Risk Response only generates a response when there is a change in matches, risk, or alerts; this could be an addition or removal of any one of these. Smart Risk Response can reduce response volume by as much as 88%!

Using our “Low Risk” example from earlier, the carrier submits an update on that claim and the new information results in the same “Low Risk” indicator with no alerts; since the company now has Smart Risk Response, no response is generated back to the company. Now a week later, they submit an update to the same claim and the risk changes to “Medium Risk” with 1 compliance alert; since the risk level and alert changed the customer receives a response with the new information.

Whether a company uses Standard Risk Response or Smart Risk Response, they can leverage the claim insights (risk level, claim alerts, and claim scoring information) to maximize workflows to assist claim handlers with decisions related to fast-tracking and investigation.

Your Verisk Account Manager can assist your organization with Risk Response setup.

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