Scan incoming claims to detect anomalies and suspicious patterns

Trigger: A new insurance claim is ingested into the claims processing system.

1. Extract claim data and supporting documents
2. Standardize and validate claimant and incident information
3. Run claim parameters against known fraud rules
4. Apply predictive models to detect behavioral or network anomalies
5. Generate an overall risk score
6. Route the claim based on established risk thresholds

Outcome: The claim is assigned a risk score and either cleared for standard processing or routed to a special investigations unit.