The Challenge
Claims often come in unstructured formats and require cross-checking with contracts, guidelines, and external data. Teams spend lots of time reading, validating, and escalating — while still missing edge cases. Errors lead to risk, delay, and customer frustration.
The Solution: Your Claims Checking Agent
We define the business rules the claims process is based on and provide your Agent with access to all relevant documents and data. Your AI agent then reads, understands, and evaluates claims — preparing everything for an automated approval or a final human decision-maker.
What the Claims Agent can do:
Extracts relevant data from claims and supporting documents, like contracts
Validates facts against business rules, master data, and guidelines customer-individually, if needed
Flags inconsistencies, missing information, or possible fraud patterns
Triggers actions or suggests next steps
Generates audit logs or status summaries
Claims Checking rules can either be configured manually for the Agent or the Agent checks the spcific rules in each individual contract
API integration with your ERP, DMS, sharepoint, internal databases, e-mail inboxes and many more
Embedded into existing claim workflows or accessible via chatbot
Business Impact
Faster Claim Turnaround – Reduce manual review time significantly —usually less than a minute.
More Reliable Checks – The Agent assures that each rule and clause are double checked, leading to more reliable checks than manual ones.
Fewer Errors & Missed Items – Avoid escalations, rework, and compliance risks.
Empowered Staff – Let your experts focus on edge cases — the agent handles the rest.
Better Reporting & Audit Trails – Every decision, flag, and action is logged and traceable.
Let’s Automate Your Claim Checks — Safely and Smartly