AI Agents

Context

Built for insurance within the Complaint & dispute stack, this agent is used when a complaint or dispute requires the carrier to confirm that the customer’s KYC record is current before resolution, or when policy rules mandate a refresh as part of handling specific case types. It runs alongside case assessment so reviewers close the complaint with a clean, evidenced KYC posture.

What it does

The agent assembles the working KYC file for the policyholder and checks that required identity fields and in-date proofs are present, correctly formatted, and consistent across the record. It reconciles names, IDs, addresses, and declarations, validates that the applied refresh cadence matches the policy/segment rules, and pinpoints exactly what is missing or stale. When gaps exist, it generates targeted ask-backs that specify the document, wording, and validity window required, and records the outcomes so the complaint proceeds only once the KYC refresh is satisfied.

Core AI functions

Document/type detection with OCR for IDs, address proofs, and declarations; normalization of names, dates, IDs, and addresses; rule evaluation against your KYC refresh policy (scope, document age, statement requirements); cross-document consistency checks to prevent conflicting fields from passing; confidence scoring that routes only material gaps to review; and reason-code generation with links to the exact page or field that triggered each finding.

Problem solved

Complaint handling often stalls on missing, expired, or mismatched KYC evidence, and rules are applied inconsistently across products and segments—creating back-and-forth with customers, late escalations, and uneven audit outcomes.

Business impact

Complaints close faster and cleaner: KYC steps are completed with precise, minimal outreach; policy adherence is consistent; and audit posture strengthens thanks to field-to-document lineage captured as part of the case.

Integration and adjacent use cases

Integration complexity: Medium. The agent reads the policyholder profile and prior KYC pack from your servicing/complaints workflow and DMS, evaluates them against current refresh rules, and writes pass/flag outcomes, evidence links, and targeted requests back to the same flow; no core changes are required.

It is commonly combined with:

• Transactional behavior risk analyzer (complaints) to provide objective activity context around the disputed period,

• Regulatory rule compliance & filing (insurance) to ensure mandated steps and records are executed, and

• SAR draft generator (insurance) to accelerate required summaries if thresholds are met during the complaint review.