AI Agent AI-Powered Claims Auto-Adjudication System Active

Fraud Detection Agent

The Fraud Hunter Agent employs anomaly detection algorithms and pattern recognition to identify suspicious claims. It analyzes billing patterns against provider profiles, detects duplicate submissions across time windows, identifies impossible service combinations, and flags statistical outliers for human review while maintaining a continuously-learning risk model.

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Parent Worker AI-Powered Claims Auto-Adjudication System

Agent ID

fraud-hunter

Portal Nexgile-FINVEST Vault

Sector Financial Services / Insurance / Multiemployer Trust Fund Administration

Status

Operational

Problem Statement

The challenge addressed

Healthcare fraud costs benefit plans millions annually through duplicate claims, phantom billing, unbundling schemes, and identity fraud—patterns difficult to detect in high-volume processing.

Core Logic

How the agent solves it

The Fraud Hunter Agent employs anomaly detection algorithms and pattern recognition to identify suspicious claims. It analyzes billing patterns against provider profiles, detects duplicate submissions... The Fraud Hunter Agent employs anomaly detection algorithms and pattern recognition to identify suspicious claims. It analyzes billing patterns against provider profiles, detects duplicate submissions across time windows, identifies impossible service combinations, and flags statistical outliers for human review while maintaining a continuously-learning risk model.

System Navigation

Explore related components

Portal

Nexgile-FINVEST Vault

Digital Worker

AI-Powered Claims Auto-Adjudication System

Current Agent

Fraud Detection Agent

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