AI Agents

Context

Built for insurance within the Insurance regulatory & compliance stack, this agent runs alongside claims and complaints handling to ensure every customer-facing message is consistent, policy-aligned, and regulator-ready—from acknowledgments and information requests to delay notices, decisions, and payment letters.

What it does

The agent reads the live case record—facts established, coverage position, timeline clocks and pauses, and required disclosures—then drafts or reviews each outgoing communication for content accuracy, tone, and mandated wording. It checks that dates, amounts, names, and references match the file; verifies that required jurisdictional disclosures and next-step instructions are present; aligns explanations with the cited policy clauses and evidence; and flags contradictions across channels (letter vs. email vs. portal). Each message returns with a concise rationale and click-through links to the source entries that justify every statement.

Core AI functions

Template-driven drafting and redlining against approved libraries; normalization of facts across workflow/DMS systems; clause/section citation from policy and rule sets; detection of omissions (missing disclosures, incomplete delay reasons), inconsistencies (dates, amounts, names), and tone/style deviations; and reason-code generation with line-of-sight to timeline events and documents.

Problem solved

Communications are often assembled ad hoc, leading to missing disclosures, inconsistent dates/amounts, and explanations that diverge from the evidence—driving complaints, rework, and regulatory findings.

Business impact

Messages become accurate, complete, and defensible on the first pass: complaint volume tied to poor communication drops, cycle time improves because ask-backs are precise, and audits proceed faster with every statement traceable to case facts and policy language.

Integration and adjacent use cases

Integration complexity: Low to medium. The agent reads case data, policy documents, and correspondence from your claims/servicing workflow and DMS, then writes reviewed/drafted communications with embedded citations back to the same case—no core changes required.

It commonly pairs within this stack with:

• Claims settlement timeline validator (to align notices with statutory clocks and pauses),

• Policy language regulatory check agent (to ensure explanations cite the correct clauses),

• Audit trail completeness verifier (to confirm each message carries required evidence and approvals), and

• Regulated document filing assistant (to reuse the same facts and citations in regulator-facing submissions).