From flagged claim to investigation report

The agent ingests all available claim data - loss details, policy information, adjuster notes, photos - and assigns an initial risk score based on known fraud indicators.

Cross-references the claimed loss against actual policy terms, coverage limits, endorsements, and exclusions. Flags coverage gaps and suspicious timing around policy changes.

Searches ISO ClaimSearch, NICB, and internal databases for prior claims by the same claimant, address, or vehicle. Identifies frequency patterns and repeat-offender signals.

Analyzes recorded statements and written narratives from all parties. Detects contradictions, timeline inconsistencies, and rehearsed language patterns across multiple accounts.

Runs forensic analysis on submitted documents - repair estimates, medical bills, receipts. Detects pixel manipulation, font inconsistencies, metadata tampering, and AI-generated fakes.

Reviews medical records for billing anomalies, pre-existing conditions presented as new injuries, excessive treatment patterns, and inconsistencies between claimed injuries and documented findings.

Scans public social media profiles, public records, and open-source intelligence for evidence that contradicts the claim - vacation photos during a disability claim, vehicle sightings after a total loss.

Identifies potential witnesses from police reports, accident scenes, and public records. Cross-references witness information against known fraud ring databases and prior claim involvement.

Builds a complete timeline of events from all available data sources - call logs, claim submissions, medical visits, repair shop interactions. Highlights gaps and impossible sequences.

Evaluates the financial context of the claim - inflated repair estimates, excessive medical billing, unusual vendor pricing patterns, and cost outliers compared to regional benchmarks.

Identifies third-party liability and recovery opportunities. Flags claims where another party may be responsible, potentially offsetting payout and reducing net loss.

Validates that the investigation meets state-specific regulatory requirements, fair claims handling guidelines, and documentation standards before report assembly.

Compiles all gathered evidence into an organized, indexed package - documents, screenshots, database results, timeline visualizations - ready for SIU review or legal proceedings.

Generates a structured investigation report with findings, risk assessment, supporting evidence, and clear recommendations - approve, deny, refer to SIU, or escalate to law enforcement.

When field surveillance is warranted, the agent generates geo-fenced surveillance plans with optimal timing windows based on claimant behavior patterns and activity analysis.