Detect and correct claims cost leakage with GPT-4 and automated alerts
Daily Claims Analysis Schedule
Workflow Configuration
Fetch Historical Claims Data
Detect Cost Leakage Anomalies
Check If Leakage Detected
AI Root Cause Classifier
openai
OpenAI GPT-4
gpt-4o
Classification Output Parser
noOp
Generate Corrective Adjustments
Aggregate Findings Report
aggregate
Send Leakage Report
smtp
No Leakage Found
Split Anomalies Into Items
splitOut
Fetch Vendor History
Fetch Policy Rules
Merge Enrichment Data
Route By Severity
Check Historical Patterns
postgres
Calculator Tool
toolcalculator
Calculate Risk Score
Check If Requires Escalation
Send Escalation Alert
smtp
Aggregate By Vendor
aggregate
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