AI Fraud Pattern Flagging Agent
Automating Fraud Pattern Flagging with AI
Surface suspicious patterns across claims in real time
The Agent continuously scans incoming and in-flight claims, cross-referencing extracted fields against your fraud rules and historical patterns to flag anomalies before they slip through.
Assemble investigation-ready case packets automatically
When a claim triggers a threshold, AI compiles a complete dossier—risk scores, rule hits, entity links, match reports, and supporting documents—so investigators start with context, not a blank screen.
Route high-priority cases to SIU with clear reason codes
Flagged claims are prioritized by severity and expected loss, then delivered to your Special Investigative Unit with transparent explanations that accelerate review and support regulatory compliance.
How Cassidy automates Fraud Pattern Flagging using AI
Step 1: Trigger on new or updated claim
The Workflow activates automatically when a claim is filed or updated in your claims management system—capturing FNOL submissions, status changes, or new documentation.
Step 2: Extract and normalize claim data
Cassidy pulls structured fields (policy details, loss information, parties involved) and uses AI to extract key data from unstructured documents like invoices, medical notes, and photos.
Step 3: Apply fraud detection rules and scoring
The Agent cross-references claim data against your Knowledge Base of fraud rules, red flag indicators, and historical patterns—scoring each claim for risk and generating clear reason codes for any flags.
Step 4: Identify entity connections and suspicious similarities
Cassidy analyzes relationships across recent claims—shared addresses, phone numbers, providers, or repair shops—to surface potential rings or repeat offenders that single-claim review would miss.
Step 5: Assemble the case packet
For claims that exceed your risk threshold, Cassidy automatically compiles a complete investigation dossier: claim synopsis, fraud score breakdown, rule hits, entity link analysis, and all relevant supporting documents.
Step 6: Route to SIU with Human-in-the-Loop approval
The case packet is prioritized by severity and routed to your SIU queue. Investigators review the AI-generated analysis and approve, adjust, or escalate—keeping your team in the driver's seat on every decision.
Implement it inside your company
- Hands-on onboarding and support
- Self-paced training for your team
- Dedicated implementation experts
- Ongoing use case discovery
- ROI tracking & analytics dashboards
- Proven playbooks to get started fast
