Insurance Claims Triage Agent

Problem

First notice of loss arrives as email, PDF, photographs, and phone transcripts. A senior adjuster reads each one to decide severity and ownership, so simple claims wait behind complex ones and the queue is triaged by arrival order rather than urgency.

Solution

An agent that extracts the facts of loss from mixed attachments, checks them against the policy in force on the date of loss, assigns a severity band and a coverage position with cited policy language, and routes to the matching queue with everything the adjuster needs already assembled.

Tech stack

Required integrations

• Claims administration system (Guidewire, Duck Creek, or in-house)
• Policy administration system for coverage in force
• Document and image storage

Key features

• Fact extraction from email, PDF, images, and call transcripts
• Coverage check against the policy in force on the date of loss
• Severity banding with the reasoning shown
• Routing to adjuster queues by line, severity, and licence
• Cited policy language on every coverage position