Benefits Fraud Detection Agent

The Benefits Fraud Detection agent evaluates Social Security disability claims for potential fraud risk.

The Benefits Fraud Detection Agent addresses the critical issue of fraud in Social Security disability claims, which can lead to financial losses and undermine the integrity of the benefits system. Fraudulent claims not only divert resources from those in genuine need but also erode public trust in the system. By automating the detection of potential fraud, this agent helps ensure that benefits are distributed fairly and efficiently.

This agent operates by analyzing two specific forms - SSA-3368-BK and SSA-16-BK - submitted as part of disability claims. It validates the claimant's information against a master database and evaluates the application against a detailed Standard Operating Procedure (SOP). The SOP includes rules for identifying suspicious patterns, such as multiple claims from the same address, frequent address changes, and inconsistencies in work history or medical documentation. Based on these evaluations, the agent assigns a fraud risk level and provides a detailed justification for its findings.

The Benefits Fraud Detection Agent utilizes UiPath Context Grounding for verifying Social Security Numbers and other claimant details. This is a mock replacement of a typical database and can be updated and periodically synced using a real system. The agent uses a structured scoring system to assess the severity of potential infractions, ranging from minor to major, and determines the overall risk level accordingly. This systematic approach ensures thorough and consistent evaluations, enabling the Social Security Administration to flag high-risk cases for further human review.

How to use

1. Click the Download button.
2. In the Downloading an agent template window, select Download Solution. A .uis file containing the agent definition is downloaded to your machine.
3. Agent templates can also include Extras, a separate package containing assets for your agent (automations, custom escalations). Select Download Extras. A .zip file is downloaded to your machine.
4. In Studio Web, import the Agent definition .uis file as described in Importing a project downloaded from Studio Web.
5. Next, go to Solutions. For details, refer to Accessing the Solutions UI.
6. Upload the .zip file, as explained in Transporting a solution package, then deploy the solution. For details, refer to Deploying the solution.
7. You can now access your agent template from Studio Web and add any other tools deployed to your tenant.

• An Agent definition purpose built for a specific task that you can open within Studio Web
• Best practices built-in including a high Agent score
• Multiple evaluation sets to ensure reliability and see example input and output
• Prebuilt tools contained within a Solutions Management file
• A starting point with the ability to expand and modify to specific needs