Intake that finishes itself before an adjuster opens it.

• 01

  First-notice-of-loss intake

  Collects the claim across chat, voice or email, extracts structured fields from whatever documents arrive, and files it complete.

• 02

  Missing-document chase

  Knows precisely which document is outstanding and why, asks for that one thing, validates the upload, and updates the claim status.

• 03

  Triage and routing

  Classifies complexity and fraud signals, routes to the right queue, and attaches the summary the handler would otherwise have written.

• 01

  The coverage decision stays with a human

  The system extracts, retrieves the applicable wording and drafts the reasoning. An adjuster confirms or overrides, and their reasoning is recorded — which is what a complaints process and an ombudsman will ask for.

• 02

  Version-aware retrieval or nothing

  Every retrieved clause carries its document version and effective date, and queries are scoped by policy inception. Quoting the wrong revision is a regulatory problem, not a UX one.

• 03

  Extraction accuracy is reported per document type

  A typed invoice and a handwritten claim form are different problems. We publish accuracy per type before you decide what to automate.

1. 1

   Use-case scoping

   Pick the workflow with the strongest ROI. Define success metrics, guardrails, and integration points.

2. 2

   Tools & memory

   Connect the agent to your real systems — CRM, helpdesk, data warehouse, internal APIs — with auth and audit trails.

3. 3

   Eval suite

   Build a versioned eval set from real conversations so we can prove the agent improves before each release.

4. 4

   Pilot with humans

   Shadow mode → suggested replies → autonomous on low-risk tasks. Humans stay in the loop where it matters.

5. 5

   Production scale

   Monitoring, fallbacks, cost guards, and observability. Weekly improvement cycles based on production data.

• Guidewire & Duck Creek
• Policy administration systems
• OCR and layout-aware extraction
• Salesforce & Zendesk
• Twilio & WhatsApp Business
• Snowflake
• Document management systems

FAQ

AI agents for claims processing: your questions.

• How does it handle suspected fraud?

  It flags signals against your existing rules and routes to the special-investigations queue with the evidence attached. It doesn't score people, and it doesn't decline anything — a model making that call is a discrimination complaint waiting to happen.

• Can it work over WhatsApp for claimants?

  Yes, and in most Indian and Gulf markets that's the channel claimants actually use. Same agent, same tools, with document upload handled in-channel.

• How is this different from a chatbot?

  Chatbots reply. Agents act. Our agents call APIs, update records, send emails, schedule meetings — with audit logs and rollback. They take actions in your systems, not just respond in a chat window.

• Which LLMs do you use?

  We pick the right model for the task — Claude Sonnet/Opus for reasoning, GPT-4o for tool use, Llama / open-weights when data residency demands it. We're not locked into any vendor and we'll tell you what's cheapest at your volume.

• RAG for insurance policy wordingRetrieval across policy wording, endorsements and claims manuals, scoped by product, territory and effective date — every answer carrying its citation.Read
• AI governance for insurersRisk classification, model documentation and oversight design for insurance use cases — built around what a complaint, an audit or an ombudsman review will ask for.Read

• AI agents for fintechAgents wired into your ledger, KYC provider and helpdesk — resolving the repetitive half of the queue end to end, and escalating the rest with the context already gathered.Read
• AI agents for healthcare operationsAgents that handle scheduling, reminders, insurance verification and document chase across voice and messaging — escalating anything clinical to a person immediately.Read
• AI customer service agents for e-commerceSupport agents connected to orders, carriers and your returns rules — resolving tracking, exchanges and address changes end to end on Gorgias, Zendesk or Intercom.Read