Insurer Fraud Detection Agent
An insurer deployed a multi-agent fraud investigation workflow — red-team tested guardrails, explainable fraud scores, and coordinated evidence gathering — reducing investigation cycle time by 35% at production scale.
An insurer deployed a multi-agent fraud investigation workflow — red-team tested guardrails, explainable fraud scores, and coordinated evidence gathering — reducing investigation cycle time by 35% at production scale.
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Challenge
Fraud investigation teams faced rising organised fraud complexity — manual evidence gathering created backlogs and inconsistent referral decisions across regions.
Production deployment — not proof-of-concept
Governed agents with full audit trails
Embedded FDE delivery model
Operational accountability through go-live
Approach
Multi-agent workflow: retrieval agent gathers evidence, scoring agent produces explainable fraud indicators, orchestrator assembles case packets for human investigators.
Policy engines blocked access to out-of-scope data. FDEE red teams tested injection, bias, and adversarial claim scenarios pre production.
Results
35% faster investigation cycles. Standardised referral quality across regions. Investigators retained decision authority with agent-prepared evidence packs.
Production outcomes, not pilot metrics.
Fraud investigation cycle time.
Critical production incidents in first 90 days.
Fraud scores with explainable features.
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Frequently asked questions
- Can Derisk360 provide references?
- Selected references are available on request during discovery calls.
- What industries are represented?
- Banking, insurance, financial services, and regulated enterprises globally.
- How do I start a similar engagement?
- Book at derisk360.com/book.