Fraud Pattern Finder

Surface suspicious claim clusters for investigation

Fraudulent claims hide among legitimate ones, connected by patterns that manual review misses.

Scheduled weekly run every Monday before SIU team meetings

On-demand request when a provider or region raises concerns

Cluster summary cards with count, exposure, and confidence score

Provider network map showing relationships between providers across claims

Request a DemoSee How It Works

Fraud Cluster Detected

Provider network anomaly • 23 linked claims

SIU Review

Linked Claims

Est. Exposure

$412K

Fraud Score

94/100

Common Provider

4 claims

Cluster Connections

Shared providerDr. Smith Clinic

Address overlap3 claimants

Timing patternAll Mon-Wed

Investigation Priority

Provider auditClaimant interviewsLaw enforcement

Built for claims teams
who catch every pattern

Fraudulent claims hide among legitimate ones, connected by patterns that manual review misses.

Claims Adjusters

Claim investigation & settlement

Claims Supervisors

Queue management & escalation

SIU Analysts

Fraud detection & investigation

Operations Managers

Operational efficiency & SLAs

From alert to action in minutes

The objective of this agent is to reduce fraud leakage by surfacing suspicious patterns earlier.

Step 1

The Trigger

You define when the agent should activate. When conditions are met, it starts working automatically.

Scheduled weekly run every Monday before SIU team meetings
On-demand request when a provider or region raises concerns
Threshold alert when claim velocity from a provider exceeds 2x historical average

Step 2

360° View

The agent opens a tailored dashboard consolidating data from all your systems.

Cluster summary cards with count, exposure, and confidence score
Provider network map showing relationships between providers across claims
Claimant relationship graph with shared addresses, phones, or beneficiaries

Step 3

Automated Analysis

The agent follows a structured analysis flow, combining checks with exploratory reasoning.

Scan for shared attributes - Identify claims sharing providers, contacts, or legal representatives
Detect billing anomalies - Flag claim stacking, upcoding, unbundling, or services inconsistent with diagnosis
Map relationship networks - Connect claimants, providers, attorneys, and facilities

Step 4

Actionable Output

After analysis, the agent creates a human-friendly report with everything your team needs.

Executive summary with total exposure, cluster count, and priorities
Cluster breakdown with exposure, claim count, and confidence score
Specific red flags (e.g., "12 claims with same provider TIN filed within 48 hours")

Step 5

Delivery

Reports are sent automatically via email or accessed directly in Veezoo.

Key benefits for operations teams

Concrete, measurable value for your team from day one

Fast Response

Faster detection

Before: 2-3 days to build investigation leads. Now: automated scans surface prioritized clusters in minutes.

Early Warning

Earlier intervention

Catch schemes after 20 claims, not 200.

Key Benefit

Quantified prioritization

Rank leads by exposure so SIU focuses on highest-impact cases.

Up and runningin production in weeks

To deploy this Agent, you connect Veezoo to your existing Data Warehouse, typically containing data from:

Claims administration system - Claim details, dates, amounts, status

Policy administration system - Policyholder and coverage information

Provider master data - TINs, NPIs, addresses, network affiliations

SIU case management (optional) - Historical fraud cases for pattern matching

Ready to explore Fraud Pattern Finder?

Fully customizable to your workflows, data sources, and business requirements.

Try for freeBook a call

Typical initial implementation in weeks, not months.