保險詐欺偵測
保險AI 比對理賠申請的模式特徵、歷史資料和外部資訊，自動標記可疑詐欺案件並產出調查建議供調查員審核。
eventagenthumansystem
為什麼需要 OSOP
保險詐欺偵測需要快速分析大量案件。OSOP 定義從特徵分析到風險評分的標準流程，確保每個詐欺標記都有清晰的依據，降低誤報率並保護合法保戶權益。
Workflow Steps (5)
1
Claims Intake Stream
event2
AI Fraud Pattern Matching
agent3
Fraud Probability Score
system4
Claims Investigator Review
human5
Claim Disposition
systemConnections (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