AI Agents

Context

Built for insurance within the Insurance regulatory & compliance stack, this agent runs alongside claims handling and complaint resolution to ensure every required step is fully evidenced—who did what, when, under which rule—and that the case file is audit-ready before closure.

What it does

The agent reconstructs the end-to-end trail from workflow events, notes, correspondence, and DMS artifacts, then checks that each milestone has the right proof attached: timestamps, user/role, approvals, cited policy or regulation, the exact document page/paragraph referenced, and any mandated customer notice. It spots gaps and inconsistencies—missing or stale evidence, unsigned or undated items, actions without authority, letters sent without the required wording—and returns precise fixes with links to the place in the file where each proof belongs. The result is a clean, navigable record in which every assertion in the case has click-through provenance.

Core AI functions

Timeline reconstruction and event normalization across systems; entity resolution for users/roles; rule mapping that ties actions to the governing clause; gap and mismatch detection on dates, signatures, and approvals; duplicate/obsolete-version control for documents; and reason-code generation that cites the specific item and rule behind each pass/flag.

Problem solved

Evidence is often scattered and uneven, making audits slow and error-prone. Missing signatures, uncited rules, or untraceable decisions trigger rework, regulatory findings, and complaints that are costly to remediate.

Business impact

Files become defensible by construction: fewer audit findings, faster examinations, lower rework, and clearer accountability. Handlers close cases with confidence because every step is traceable to the page, person, and policy clause that justified it.

Integration and adjacent use cases

Integration complexity: Low to medium. The agent reads workflow events, correspondence, and documents from your claims/servicing system and DMS, writes pass/flag outcomes with deep links back to source, and stores a versioned audit checklist—no core changes required.

It commonly pairs within this stack with

• Claims settlement timeline validator to ensure every clock pause and restart carries evidence,

• Policy language regulatory check agent to verify that coverage decisions cite the right clauses,

• Customer communication consistency agent to confirm required disclosures and tone across notices, and

• Regulated document filing assistant to assemble submissions using the same evidence trail.