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Score Claims for Fraud Risk to Prioritize Investigations

Benefits:

Efficiency, Resource Optimization, Risk Management

Category:

Fraud Detection & Prevention

Use Case

Not all claims warrant the same level of scrutiny. LLMs can analyze multiple risk factors identified during claims processing (anomalies, inconsistencies, suspicious patterns) to generate an overall fraud risk score for each claim. This allows insurers to prioritize investigative resources, focusing efforts on the highest-risk claims while potentially fast-tracking low-risk ones.

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