Marketplace Claims Resolution
Evidence-driven claims adjudication engine — analyzes disputes, images, and order data to determine validity, fraud risk, and severity.
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Marketplace Claims Resolution · Agent Mesh
Claim Intake
Claim submitted through portal, email, or API with supporting evidence.
Key Features
Evidence Analysis
AI analyzes submitted evidence including images, messages, and order data.
Fraud Detection
Pattern-based fraud detection using historical claims and behavioral signals.
Severity Scoring
Automated severity assessment to prioritize high-impact claims.
Policy Matching
Map claims to applicable policies and coverage rules automatically.
Decision Support
Provide recommended decisions with explanations and supporting evidence.
Appeals Management
Handle appeals with additional evidence review and escalation workflows.
How It Works
Claim Intake
Claim submitted through portal, email, or API with supporting evidence.
Evidence Analysis
AI analyzes all submitted evidence for authenticity and relevance.
Fraud Screening
Automated fraud detection using pattern and behavioral analysis.
Policy Mapping
Map claim to applicable policies and coverage rules.
Severity Assessment
Calculate claim severity and prioritize processing.
Adjudication
AI makes or recommends claim decision with full explanation.
Communication
Notify claimant of decision with detailed explanation.
Analytics & Learning
Continuous learning from outcomes to improve future decisions.
Multi-Agent Architecture
Evidence Agent
Analyzes submitted evidence including images, documents, and communications.
- Image analysis
- Document parsing
- Communication review
- Evidence scoring
- Authenticity check
Fraud Agent
Detects fraudulent claims using pattern analysis and behavioral signals.
- Pattern detection
- Behavioral analysis
- Network analysis
- Risk scoring
- Investigation support
Adjudication Agent
Makes claim decisions based on evidence, policy, and risk assessment.
- Decision making
- Policy application
- Evidence weighing
- Explanation generation
- Consistency checking
Communication Agent
Manages claimant communications and status updates.
- Status updates
- Information requests
- Decision delivery
- Sentiment monitoring
- Escalation triggers
Analytics Agent
Provides insights on claim trends, fraud patterns, and operational metrics.
- Trend analysis
- Pattern identification
- Performance metrics
- Predictive analytics
- Reporting
Use Cases
E-Commerce Disputes
Resolve buyer-seller disputes with automated evidence analysis.
Insurance Claims
Process insurance claims with AI-powered assessment and adjudication.
Payment Disputes
Handle payment disputes and chargebacks with automated investigation.
Product Returns
Automate return eligibility decisions based on policy and evidence.
Service Complaints
Resolve service quality complaints with evidence-based decisions.
Fraud Investigations
Support fraud investigations with pattern analysis and evidence review.