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Insurance Claim Fraud Analyzer

by recued-core v1 action

Evaluates new insurance claims for fraud indicators using rule-based checks and AI consistency analysis.

How it works

Process (18 steps)
■ late_days date_diff
Calculate days between claim date of loss and claim date reported
■ late_flag compare
Check if late days is greater than setting late reporting threshold days
■ freq_flag compare
Check if policyholder prior claims count is at least setting high frequency threshold
■ threshold_amt math
Calculate setting avg claim for type times 2
■ amount_flag compare
Check if claim amount is greater than threshold amt
■ hashed_claim hash_replace
Anonymize sensitive fields for safe AI processing
✦ desc_check ai-classify
AI classifies data into one of the given categories
■ restored_ai hash_restore
Restore anonymized fields back to real values
■ desc_flag compare
Check if desc check category does not equal consistent
■ any_flag any
Check if any of the conditions are true
■ count_2 math
Calculate late flag plus freq flag
■ count_3 math
Calculate count 2 plus amount flag
■ flag_count math
Calculate count 3 plus desc flag
■ risk_level switch
Map flag count to one of: 0, 1, 2, 3, 4
■ ai_ready all
Check if all conditions are true
✦ ai_explanation ai-prompt
AI generates a response from a custom prompt
skip: step.ai_ready equal false
■ checklist to_checklist
Format results as an actionable checklist
■ summary to_summary
Format results as a summary card
▼
Output
summary summary
checklist checklist
ai_analysis ai_explanation

Settings (4)

Configurable at install. Defaults shown — change anytime in the extension.

enable ai toggle = on
avg claim for type number = 10000
high frequency threshold number = 3
late reporting threshold days number = 14

Tags

insurance insurancefraudclaim

Details

18 steps 4 configurable settings recipe_id: analyze-claim-fraud-insurance

Install

Install in Recued View publisher Open Kitchen

If the webclient is not paired yet, copy analyze-claim-fraud-insurance and paste it after pairing.