The problem
Fraud signals are spread across claims and outside data, so investigators get referrals late and spend their time on paperwork.
What changes
- Earlier, better-prioritized fraud referrals
- Ready-to-use case briefs and plans
- Less routine paperwork for investigators
Full specification
The complete specification for Claims Fraud Detection & SIU Case Agent is shared with your team under NDA as part of a demo or evaluation. It covers:
- Step-by-step workflow and human approval points
- Tools, systems and access levels
- Guardrails and regulatory mapping
- Handoffs to other agents and teams
- Evaluation set (L1–L5) and results
- Model risk documentation