Enterprise Portfolio Risk Assessment Digital Worker

Core Logic

The Workflow Orchestrator manages the complete assessment lifecycle from portfolio selection through final results delivery. Using GPT-4 Turbo with 0.1 temperature for deterministic coordination, it routes tasks to appropriate agents, manages state through checkpoints, handles escalations to supervisors, coordinates parallel agent execution for independent analyses, and maintains comprehensive audit trails. The orchestrator supports up to 10 concurrent tasks and enables memory persistence for context continuity across workflow phases.

Core Logic

The Data Collection Agent connects to six data source types: policy administration systems, claims data warehouses, provider network databases, actuarial data stores, external market APIs, and regulatory feeds. It validates data quality through completeness checks, consistency validation, and freshness verification. The agent processes hundreds of thousands of records, normalizes data formats, tracks data lineage for audit purposes, and provides real-time progress updates with record counts and quality scores. It uses GPT-4 Turbo with 0 temperature for deterministic data operations.

Core Logic

The Risk Analysis Agent performs comprehensive risk scoring using ML models for pattern detection and anomaly identification. It analyzes risk across dimensions including medical inflation, claims frequency, geographic concentration, provider network gaps, and segment-specific risks. The agent uses correlation engines to identify risk factor relationships, trend analyzers for trajectory assessment, and produces risk scores (0-100) with severity classifications (low, moderate, high, critical). Evidence chains document all findings with confidence scores, enabling explainable risk assessments.

Core Logic

The Actuarial Agent performs reserve calculations including IBNR (Incurred But Not Reported) estimation using stochastic engines. It analyzes pricing adequacy by comparing premium rates against projected claim costs, performs segment-level profitability analysis, runs actuarial projections with confidence intervals, and validates assumptions against industry standards. The agent uses GPT-4 Turbo with 0.1 temperature and supports memory for maintaining actuarial context across analyses.

Core Logic

The Fraud Detection Agent employs ML-powered fraud scoring, graph-based network analysis for fraud ring detection, pattern matching against known fraud indicators, and SIU (Special Investigation Unit) database cross-referencing. It scores claims for fraud likelihood, identifies suspicious provider billing patterns, detects coordinated schemes through relationship analysis, and prioritizes cases for investigation. The agent produces fraud risk scores with supporting evidence and estimated financial exposure for flagged claims.

Core Logic

The Recommendation Agent synthesizes findings from all analysis agents, applies priority ranking based on impact and urgency, calculates expected ROI for each recommendation, assesses implementation complexity and resource requirements, identifies dependencies between recommendations, and produces implementation roadmaps. Using GPT-4 Turbo with 0.3 temperature for creative solution generation, it generates alternative approaches for major recommendations with pros/cons analysis.

Core Logic

The Market Intelligence Agent monitors real-time market trends through news aggregation, analyzes competitor pricing and product changes through market APIs, tracks regulatory developments across jurisdictions, and identifies market shifts affecting portfolio strategy. It produces market intelligence reports with impact assessments, competitive positioning analysis, and strategic recommendations aligned with market conditions.

Core Logic

The Predictive Analytics Agent runs ML pipelines for claims forecasting using time-series models, churn prediction identifying at-risk members and policies, cost driver analysis detecting emerging expense categories, and trend inflection point detection. It accesses feature stores for model inputs, executes predictions through model registries, and produces forecasts with confidence intervals and key driver explanations. The agent highlights high-impact predictions requiring intervention.

Core Logic

The Compliance Guardian Agent performs real-time compliance checking against regulatory databases, validates policies against HIPAA privacy and security requirements, monitors GDPR data protection compliance, checks IRDAI regulatory adherence for Indian operations, tracks remediation progress for identified gaps, and maintains compliance audit logs. Using GPT-4 Turbo with 0 temperature for deterministic compliance decisions, it produces compliance scorecards with gap details and remediation recommendations.

Core Logic

The Autonomous Execution Agent executes approved actions with configurable guardrails including approval thresholds, action limits, and rollback capabilities. It validates proposed actions against safety constraints, executes low-risk actions with auto-approval, escalates high-risk actions for human review, maintains execution audit trails, and provides rollback functionality for reverting unsuccessful actions. The agent uses notification services to alert stakeholders of autonomous actions taken.

Core Logic

The Emerging Risk Monitor tracks industry-specific emerging risks using trend analyzers, medical literature APIs, and scenario modeling. It monitors GLP-1 medication adoption and projected impact on claims, mental health utilization trends post-pandemic, telehealth substitution effects on cost structures, climate-related health condition patterns, and gene therapy cost emergence. The agent produces impact projections with timeframes, affected policy segments, and recommended portfolio adjustments. Using GPT-4 Turbo with 0.3 temperature for creative scenario exploration, it identifies emerging risks before they materialize in claims data.