The challenge
Claims teams assemble information from forms, correspondence, invoices, and policy documents. Missing evidence and inconsistent details create repeated follow-up and fragmented review.
The solution
An intake agent classifies files and extracts agreed claim details. A validation agent checks the packet against a configured evidence checklist, while RAG retrieves relevant policy passages with citations. A coordination agent prepares follow-up drafts and a source-linked case summary for the adjuster.
Project scope & evaluation
The scope covers document review, a missing-evidence queue, case timelines, and adjuster review. Evaluation focuses on extraction accuracy, checklist completeness, citation quality, and reviewer corrections. Coverage decisions, denials, and settlements remain with authorized claims professionals.