AI Agent for Insurance Claim Processing
AI that reviews claims but can't approve payments or access unrelated records.
The problem
Automating insurance claim processing requires access to sensitive patient records and policy details. Most AI solutions either have broad system access (risking data leaks) or rely on external APIs (exposing PHI to third parties). Even well-intentioned agents could accidentally approve fraudulent claims if given payment authority.
How ConspiracyOS handles it
This agent gets read-only access to claim documents and policy databases. It can flag discrepancies or missing information, but all decisions route to human reviewers. The system physically prevents the agent from accessing unrelated patient records or financial systems.
What this agent can't do
- Approve or deny claims (only recommends)
- Access medical records outside the current claim
- Modify any database entries
- Communicate with payment systems
- See policyholder SSNs or full birthdates
These aren't trust-based restrictions. The operating system enforces them.
What you get
- 24/7 claim triage without compliance risks
- Faster processing by flagging incomplete submissions
- Automatic policy cross-checks with human oversight
- No accidental approvals—all decisions require human sign-off
Get started in 2 minutes
Tell your concierge what you need
conos "conos create-agent --name claim-reviewer --scope read-claims-docs,read-policy-details --instructions "Review submitted claims against policy terms""
ConspiracyOS sets up the right agent with the right permissions automatically.