Insurance Claim Fraud Detection

Insurance

Claims stream processed by AI pattern matching, assigns fraud probability score, flags suspicious claims for investigator review.

eventagenthumansystem
Why OSOP matters here

Insurance fraud costs $80B annually. OSOP records every risk signal, pattern match, and investigator decision — building a dataset to continuously improve fraud detection models.

Workflow Steps (5)

1
Claims Intake Stream
event
2
AI Fraud Pattern Matching
agent
3
Fraud Probability Score
system
4
Claims Investigator Review
human
5
Claim Disposition
system

Connections (5)

Claims Intake Stream→AI Fraud Pattern Matchingsequential
AI Fraud Pattern Matching→Fraud Probability Scoresequential
Fraud Probability Score→Claim Dispositionconditionalfraud_score.value < 20
Fraud Probability Score→Claims Investigator Reviewconditionalfraud_score.value >= 20
Claims Investigator Review→Claim Dispositionsequential
5
Steps
5
Connections
4
Node Types
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