Claims Investigator
Claims Fraud Analysis
This agentic task detects and analyses potential insurance fraud patterns - critical for claims investigation agents. The task specification outlines how to:
Analyse cross-referential anomalies across claims data and supporting documentation
Generate risk-weighted investigation priorities with confidence metrics
Identify suspicious claim elements through pattern recognition algorithms
Produce structured fraud analysis reports with evidence-based recommendations
As a modular agentic task, it can be integrated into claims management and investigation workflows, enabling AI agents to execute systematic fraud detection within existing systems. The task specification includes outputs for anomaly detection, risk scoring, evidence assessment, and investigation prioritisation, adaptable to motor, home, and health insurance products.
Example outputs: