AI Agents

Context

Designed for insurance within the Underwriting assessment stack, this agent is used when an application includes medical disclosures and supporting evidence (reports, labs, imaging, prescriptions). It runs alongside medical questionnaire review so underwriters see a clean, evidenced picture of the applicant’s health status before pricing and decisioning.

What it does

The agent reads the submitted medical evidence and validates the applicant’s declared conditions against what the records actually show—diagnoses, dates, severity, treatment status, medications, outcomes, and follow-ups. It checks that reports are complete and in-date, reconciles terminology across documents, flags contradictions (for example, a “resolved” condition with ongoing medication), and highlights missing items that would normally be required for assessment. The output is a structured health profile with a concise rationale per finding and click-through links to the exact page and line in the source evidence.

Core AI functions

Document detection and parsing tuned to clinical artefacts; OCR and entity extraction for diagnoses, procedures, lab values, imaging impressions, medications, and dates; normalization of clinical terminology and units; cross-document consistency checks against declared disclosures; freshness/validity checks for reports and tests; and reason-code generation that explains each pass/flag with field-level lineage to the evidence.

Problem solved

Medical evidence arrives in varied formats and language, and manual reconciliation against disclosures is slow and error-prone. Omissions, stale tests, or contradictions surface late, causing rework, inconsistent outcomes, and avoidable delays.

Business impact

Underwriting moves faster with cleaner files: disclosures are verified against objective evidence, gaps are identified early with precise ask-backs, pricing reflects current risk, and decisions are more consistent and defensible with an audit trail that links conclusions to source.

Integration and adjacent use cases

Integration complexity is medium: The agent ingests PDFs or scanned reports from portal/agent capture, email, or DMS and writes structured findings, flags, and evidence links into the underwriting workbench or policy admin; exceptions route to existing queues, and core systems are unchanged.

It is commonly paired with:

• Medical questionnaire analyzer (to structure applicant responses),

• Risk tier assignment agent (to translate verified health status into a tier recommendation),

• Income & occupation verifier (where financial suitability is required),

• Asset & usage pattern extractor (P&C) (for non-medical context), and

• Manual exception escalation wrapper (to route complex cases with a complete evidence pack).