ClaimShield – Fraud Detection Agent

This agent makes the final fraud decision on insurance claims. ClaimShield consumes risk scores and flags from earlier agents, uses Gemini to validate them, and makes a confidence-based fraud prediction.

The agent monitors outputs from all upstream agents, aggregates risk indicators, and calculates fraud scores with weighted logic. It reviews claim data such as image authenticity results, incident timing, and user behavior, and cross-checks against similar past claims. It applies rules for repeat damage in short intervals, duplicate image submissions, and conflicting metadata. Borderline cases go to human review automatically, and thresholds adapt to historical fraud trends. Insurance companies use it to detect fraudulent claims, process claims faster, and reduce manual review, achieving a 40 percent reduction in undetected fraud while prioritizing honest claims.