Conversation Audit & Compliance Monitoring Agent
Monitors and flags abusive or non-compliant chat, email, and call interactions in real time
Description
Challenge:
In claims servicing, human-AI and handler-claimant interactions are core to decision-making, but they’re often undocumented, unmonitored, or prone to misconduct—like abusive behavior, policy misrepresentation, or coercion. These create legal, regulatory, and reputational risks, especially when there’s no structured audit trail. Without real-time flagging, violations often go unnoticed. The Conversation Audit & Compliance Monitoring Agent closes this gap by logging every message across channels, detecting violations via NLP, and triggering real-time compliance alerts.
How It Works:
Once deployed, the agent captures every interaction across platforms—whether it's chatbot, email, or voice-to-text from calls. Each message is passed through a natural language processing (NLP) engine trained on policy violation categories such as abuse, misrepresentation, sensitive info sharing, or fraud threats. Based on configurable compliance rules, messages are either logged silently or flagged with alert severity. Logs are mapped to user roles, stored in tamper-proof repositories, and made available via dashboards or case files for internal reviews and regulatory audits.
Benefits:
Enables 100% traceable, tamper-proof record of human-AI interactions
Detects 90–95% of abusive, misleading, or non-compliant behavior using NLP
Reduces legal disputes by ensuring documented, rule-driven moderation
Flags policy violation risks within 10 seconds of message receipt
Ensures regulatory adherence (IRDAI, HIPAA, etc.) through automated monitoring
Strengthens trust in digital claims handling through transparent communication oversight
Features
This agent acts as a real-time monitoring system across all conversation channels. It enforces communication standards by applying NLP models, compliance rules, and message categorization logic. All flagged interactions are stored with detailed context for downstream reviews, dispute resolution, or audit inspection.
Features & Capabilities:
Cross-Channel Logging: Captures chatbot, email, and call transcripts with metadata
NLP-Based Violation Detection: Flags abusive tone, coercive language, and misleading claims
Audit Trail Generator: Stores logs in immutable format with full traceability
Compliance Rule Engine: Applies IRDAI, HIPAA, and internal communication standards
Role Mapping: Associates messages with claimants, agents, or system bots
Real-Time Alerts: Notifies compliance teams on severity breaches (e.g., threats or fraud risk)
Escalation Integration: Sends flagged logs to case managers or supervisors for further action
Retention Management: Retains messages as per defined audit policy duration
Violation Categorization: Tags interactions as abuse, fraud attempt, sensitive info breach, etc.
Dashboard & API Access: Makes audit logs and flags available for BI tools and compliance portals
Eligibility Logic
Decision Logic Flow:
The agent uses a layered violation detection and rule-matching process. Each incoming message is evaluated for risk and compliance breach, allowing enforcement in real time.
Key Logic Pathways Followed:
Log Every Interaction Rule: Every incoming/outgoing message is captured with timestamp, user identity, and channel source.
Abusive Language Detection Rule: Detects profanity, threats, coercive phrases, and flags based on NLP risk scores.
Sensitive Info Disclosure Check: Flags if restricted info (passwords, medical records, account PINs) is shared.
Escalation Rule: Messages breaching severity threshold (e.g., repeated abuse, suspected fraud) are auto-flagged.
Audit Retention Policy Rule: Ensures logs are stored for the mandatory audit duration (e.g., 5–7 years).
Violation Categorization Rule: Tags and classifies issues into buckets—abuse, misrepresentation, regulatory breach—for faster triage and reporting.
