Forward to: Claims Team

Claims Investigation
Workflows

Ten agent workflows for the Claims Team — fraud detection through digital footprint analysis, claimant business verification, repair shop and vendor vetting, claims pattern recognition, suspicious provider identification, staged accident detection, medical provider validation, subrogation target intelligence, litigation risk assessment, and claims leakage prevention.

1Claimant Business Verification

AI agent verifies claimant business legitimacy by analyzing their web presence — detecting shell companies, inflated business valuations, and fraudulent loss claims through domain intelligence cross-referencing.

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Verify Claimant Business Existence
/about /contact /products /careers Domain Ages OpenPageRank
CLAIMANT VERIFICATION — CLAIM #CLM-2026-12847 ════════════════════════════════════════════════════════ Claimant: Elite Luxury Imports LLC Domain: eliteluxuryimports.com Claim: $2.4M business interruption — warehouse fire VERIFICATION RESULTS: Domain Age: 67 days | PageRank: 0.0/10 /about: "Premier luxury goods importer since 2019"CONFLICT: Domain registered 67 days ago, claims 7 years /products: Stock photos, no actual inventory shown /contact: Gmail address, no business phone /careers: Not present | /leadership: Not present Web Filtering: Uncategorized FRAUD INDICATORS: 8/10 - Domain age contradicts claimed business history - Zero web authority for a "$15M revenue" company - No employee presence (careers/leadership absent) - Stock imagery suggests no real operations ACTION: Refer to SIU for full investigation
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Cross-Reference Against Legitimate Claims
Verification Impact
Claims Verification Results — Of 234 business interruption claims this quarter, domain intelligence flagged 18 (7.7%) with material discrepancies. SIU confirmed fraud in 14 cases, saving $8.2M in fraudulent payouts. False positive rate: only 2.1% — legitimate claimants are not delayed.
$8.2M fraud prevented this quarter

2Repair Shop & Vendor Vetting

AI agent evaluates repair shops, contractors, and service vendors used in claims — identifying legitimate businesses versus fraudulent or inflated-billing operations through comprehensive domain analysis.

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Vet Claims Service Providers
/about /pricing /contact /legal Domain Ages OpenPageRank Web Filtering
VENDOR VETTING — AUTO CLAIMS REPAIR SHOPS (Q1 2026) ════════════════════════════════════════════════════════ APPROVED — High Confidence precisionautobody.com Age: 4,380 days | PR: 3.8 | /about: Est. 2008, ASE certified /pricing: Transparent labor rates posted | /contact: 3 locations Consistent with legitimate, established shop FLAGGED — Suspicious Vendor premiumrepairspecialists.net Age: 42 days | PR: 0.0 | /about: Vague, no certifications /pricing: Not present | /contact: Cell phone only /legal: Not present — no business license references Submitted 12 invoices in 6 weeks, avg $8,400 each PATTERN: New entity, high volume, no web legitimacy ACTION: Suspend payments, refer to SIU, audit all invoices MONITORING — New Vendor quickfixautoglass.com Age: 189 days | PR: 1.2 | /about: "Locally owned" Too new to fully assess — limit to $2K per claim

3Fraud Ring Detection

AI agent identifies fraud rings by analyzing domain relationships across multiple claims — detecting shared infrastructure, common registration patterns, and linked business entities that indicate organized fraud schemes.

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Map Domain Relationships Across Claims
/about /contact /legal Domain Ages Countries Web Filtering
FRAUD RING DETECTION — CLUSTER ANALYSIS ════════════════════════════════════════════════════════ RING IDENTIFIED — Cluster #FR-2026-034 Connected entities across 23 claims ($1.8M total): southfloridarestoration.com — Restoration contractor rapidwaterdamage.com — Water damage services elitemooldremoval.net — Mold remediation premiumpaintpros.com — Painting services SHARED INDICATORS: All domains: Registered within 30-day window All domains: Same hosting provider (offshore) /contact pages: Overlapping phone numbers /about pages: Similar template language All claims: Filed through same 2 public adjusters PATTERN: Coordinated water damage claims ring Estimated exposure: $1.8M paid, $3.2M pending ACTION: Freeze all pending payments, notify NICB, SIU takeover

4Medical Provider Validation

AI agent validates medical providers involved in injury claims — verifying practice legitimacy, identifying suspicious billing patterns, and detecting provider mills through web presence analysis.

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Validate Medical Provider Legitimacy
/about /leadership /contact /compliance Domain Ages OpenPageRank
MEDICAL PROVIDER VALIDATION — WORKERS COMP CLAIMS ════════════════════════════════════════════════════════ FLAGGED — Suspicious Provider advancedpainmanagement247.com Domain Age: 91 days | PageRank: 0.1 /about: No physician names, generic facility description /leadership: Not present — no doctors listed /compliance: Not present — no HIPAA or accreditation references Claims volume: 87 referrals in 3 months (unusually high) Avg bill: $12,400 (3.2x market average) VERDICT: Possible provider mill — refer to SIU VALIDATED — Legitimate Provider oregonorthopedics.com Domain Age: 6,205 days | PageRank: 4.7 /about: Est. 1998, 12 board-certified physicians /leadership: Full physician directory with credentials /compliance: Joint Commission accredited VERDICT: Established, legitimate practice

5Subrogation Target Intelligence

AI agent identifies and evaluates subrogation recovery targets — assessing third-party financial strength, insurance coverage indicators, and business viability through domain intelligence to maximize recovery potential.

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Assess Subrogation Recovery Potential
/about /investors /press /legal OpenPageRank Domain Ages
SUBROGATION TARGET ASSESSMENT — 12 PENDING RECOVERIES ════════════════════════════════════════════════════════ HIGH RECOVERY POTENTIAL — $4.2M at stake nationaltruckfleet.com — Claim: $1.8M auto liability PR: 6.8 | Age: 14yr | /investors: Public company (NYSE) /about: 4,200 employees, $890M revenue Excellent financial strength — pursue aggressively industrialchemcorp.com — Claim: $2.4M product liability PR: 5.4 | Age: 11yr | /about: Fortune 1000 subsidiary Strong parent backing — demand letter within 30 days LOW RECOVERY POTENTIAL — $890K at stake budgetcontractorsllc.net — Claim: $340K property damage PR: 0.3 | Age: 234 days | /about: "Small team" Likely judgment-proof — minimize legal spend quickhaul-transport.com — Claim: $550K auto liability PR: 0.8 | Age: 1.2 years /press: Recent layoff announcement Financial distress — negotiate quick settlement

6Litigation Risk Assessment

AI agent evaluates litigation risk for open claims by analyzing claimant attorney firms, expert witnesses, and opposing parties through domain intelligence — predicting case outcomes and optimal reserve levels.

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Assess Attorney & Expert Witness Profiles
/about /case-studies /leadership /blog OpenPageRank Domain Ages
LITIGATION RISK — CLAIM #CLM-2026-9847 ════════════════════════════════════════════════════════ Claimant Attorney: morgansternlaw.com PR: 7.2 | Age: 8,401 days | /about: "Top 50 PI firm" /case-studies: $47M average verdict in similar cases /leadership: 12 partners, all with 15+ years experience /blog: Recent article on exact same injury type /press: 3 record verdicts in past 2 years LITIGATION RISK: VERY HIGH — Elite plaintiff firm Expert Witness: drsmithforensics.com PR: 3.4 | /about: Board-certified forensic specialist /case-studies: Testified in 200+ cases CREDIBILITY: HIGH — Well-established expert RECOMMENDATION: Increase reserve from $450K to $1.2M Engage tier-1 defense counsel immediately Consider early mediation — settlement range $600K-$900K

7Claims Pattern Analysis

AI agent identifies emerging claims patterns by correlating domain intelligence with claims data — detecting systemic issues, seasonal trends, and geographic clusters before they impact the book.

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Detect Emerging Claims Patterns
/products /press /blog IAB Categories Web Filtering
CLAIMS PATTERN DETECTION — FEBRUARY 2026 ════════════════════════════════════════════════════════ EMERGING PATTERN #1: E-bike Battery Fires 12 property claims in 60 days (vs. 2/month baseline) All involve e-bike/e-scooter battery charging Manufacturer domains analyzed: velocitye-bikes.com — /products: Model X-700 battery urbanriderco.com — /press: No recall notices IAB cluster: Electric Vehicles & Micromobility ACTION: Issue underwriting bulletin, review e-bike exposures EMERGING PATTERN #2: Restaurant Slip-and-Fall Cluster Southeast region: 34 GL claims in 45 days (+180% vs. baseline) Common factor: New restaurant chains expanding rapidly fastwokexpress.com — /careers: 47 positions (rapid hiring) burgerblastusa.com — /press: 23 new locations this quarter Rapid expansion + new staff = insufficient training ACTION: Review all rapid-growth restaurant accounts

8Catastrophe Claims Triage

AI agent accelerates catastrophe claims processing by pre-verifying insured businesses, prioritizing claims by business criticality, and identifying which affected businesses are most likely to have legitimate large losses.

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Triage CAT Claims by Business Profile
/about /products /careers OpenPageRank IAB Categories Countries
CAT TRIAGE — HURRICANE EVENT (847 CLAIMS FILED) ════════════════════════════════════════════════════════ PRIORITY 1 — Large Verified Operations (89 claims) Pre-verified via domain intelligence: legitimate, large businesses gulfcoastmedical.org — Hospital, 800 employees southerntextiles.com — Manufacturing, 340 employees Fast-track: Assign senior adjusters, expedite payments PRIORITY 2 — Standard Verified (612 claims) Domain intelligence confirms legitimate businesses, smaller scale Standard adjuster assignment, normal processing PRIORITY 3 — Enhanced Scrutiny (146 claims) Domain intelligence flags requiring verification: - 34 claims: Domain age <1 year (possible storm-chasing) - 28 claims: No web presence found (verify business exists) - 84 claims: Claimed damages exceed business profile ACTION: SIU screening before payment, require documentation

9Claims Leakage Prevention

AI agent identifies claims leakage by comparing actual payments against expected costs based on business profiles — detecting overpayments, unnecessary services, and inflated estimates before they are finalized.

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Detect Payment Anomalies
/about /pricing /products OpenPageRank IAB Categories
CLAIMS LEAKAGE ANALYSIS — JANUARY 2026 ════════════════════════════════════════════════════════ LEAKAGE DETECTED — 23 claims flagged ($1.2M potential savings) Claim #CLM-2026-8912: Business interruption — $340K claimed smalltownbakery.com /about: "Family bakery, 4 employees" | PR: 1.2 BI claim inconsistent with business scale Expected BI exposure: $45K-$80K based on web profile Savings: $260K-$295K Claim #CLM-2026-9034: Equipment replacement — $180K claimed Vendor: premiumequipmentbrokers.com /pricing: Same equipment listed for $87K on vendor site Invoice inflated 2x vs. vendor's own published pricing Savings: $93K MONTHLY LEAKAGE SUMMARY: Claims reviewed: 1,847 | Leakage flagged: 23 (1.2%) Potential savings: $1.2M | Confirmed savings: $890K

10Claims Performance Dashboard

AI agent generates comprehensive claims performance analytics — measuring fraud detection rates, recovery improvements, leakage prevention, and overall claims handling efficiency powered by domain intelligence.

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Generate Claims Intelligence Report
/about /products OpenPageRank Domain Ages IAB Categories

Claims Intelligence Impact — Q1 2026

FRAUD DETECTION ──────────────────────────────────────── Claims screened: 4,891 | Fraud referrals: 187 (3.8%) SIU confirmed fraud: 142 | Fraud prevented: $12.4M Detection accuracy: 76% (was 31% pre-intelligence) VENDOR MANAGEMENT Vendors vetted: 342 | Flagged: 28 (8.2%) Vendor fraud confirmed: 19 | Savings: $3.8M SUBROGATION RECOVERY Targets assessed: 89 | Recovery rate: 72% (was 41%) Total recovered: $8.7M (up $3.4M from prior year) CLAIMS LEAKAGE Leakage detected: $4.8M | Recovered: $3.6M TOTAL ANNUAL VALUE: $28.5M ROI: 1,140x return on database investment
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