AI 保險理賠評估

Human → AI

AI 從照片評估損害並核查保障範圍，理賠員做出最終決定。

5 個節點 · 5 條連接insurance

agenthumansystem

視覺化

提交理賠申請human

保戶上傳理賠申請表、照片及事故說明。

↓sequential→ AI 損害評估

AI 損害評估agent

分析照片以估算損害類型、嚴重程度與修復費用。

↓sequential→ 保障範圍核驗

保障範圍核驗system

比對理賠申請與保單條款、自付額及除外責任。

↓sequential→ 理賠員審查

理賠員審查human

理賠員審查 AI 評估結果與保障認定。

↓sequential→ 處理理賠結案

↓fallback→ AI 損害評估

處理理賠結案api

向保戶發出給付通知或拒賠通知。

在編輯器開啟

uc-claim-assessment.osop.yaml

osop_version: "1.0"
id: "ai-claim-assessment"
name:"AI 保險理賠評估"
description:"AI 從照片評估損害並核查保障範圍，理賠員做出最終決定。"

nodes:
  - id: "submit_claim"
    type: "human"
    subtype: "input"
    name: "提交理賠申請"
    description: "保戶上傳理賠申請表、照片及事故說明。"

  - id: "ai_damage"
    type: "agent"
    subtype: "llm"
    name: "AI 損害評估"
    description: "分析照片以估算損害類型、嚴重程度與修復費用。"
    security:
      risk_level: "medium"

  - id: "coverage_check"
    type: "system"
    name: "保障範圍核驗"
    description: "比對理賠申請與保單條款、自付額及除外責任。"

  - id: "adjuster_review"
    type: "human"
    subtype: "review"
    name: "理賠員審查"
    description: "理賠員審查 AI 評估結果與保障認定。"
    security:
      approval_gate: true

  - id: "settle"
    type: "api"
    subtype: "rest"
    name: "處理理賠結案"
    description: "向保戶發出給付通知或拒賠通知。"

edges:
  - from: "submit_claim"
    to: "ai_damage"
    mode: "sequential"
  - from: "ai_damage"
    to: "coverage_check"
    mode: "sequential"
  - from: "coverage_check"
    to: "adjuster_review"
    mode: "sequential"
  - from: "adjuster_review"
    to: "settle"
    mode: "sequential"
  - from: "adjuster_review"
    to: "ai_damage"
    mode: "fallback"
    label: "Request additional photo analysis"