Claim Fraud Detection Agent
Investigates suspicious claims by comparing them with other claims and outside information.
The challenge
Problems are spotted late, because nobody has time to keep watching every account, shipment, machine or deadline.
How it works
- 1The agent keeps watch over your data.
- 2Most of what it sees is normal, and it carries on watching.
- 3When something looks wrong, it works out the likely cause and who is affected.
- 4It opens a case in your system and prepares a recommended response.
- 5The right person is alerted, with the evidence and a suggested next step.
Your people stay in control
The agent raises the alert and suggests what to do. Your team decides what action to take.
Systems we work with in Insurance
- Policy administration
- Claims management
- Rating engines
- Broker portals and bordereaux
- Third-party data such as weather, vehicle and property
How we measure success
- How early problems are caught
- How many alerts turn out to be real
- How quickly alerts are acted on
Kind of work
Monitoring and alerts. The agent keeps watch around the clock and alerts the right person when something needs attention.
More in Insurance
Loss Prevention AgentContacts customers with advice on avoiding losses, based on their circumstances and changing conditions such as weather.New Claim Intake AgentTakes a new claim in one conversation, gathers the evidence and sends it to the right handler.Commercial Underwriting Submission AgentReads applications for business insurance, extracts the details, checks them against what you will insure and prepares the file for the underwriter.Policy Explanation AgentExplains to customers in plain language what their policy covers, quoting the relevant section.
Want this working in your organisation?
We can show it working on real examples from your business before you commit to a full build.