AI Agents

Context

Built for insurance within the Complaint & dispute stack, this agent runs during case handling to ensure required policy steps, disclosures, timelines, and filings are executed completely and on time. It is applied alongside assessment and resolution so a complaint progresses only when mandated actions are satisfied and evidenced.

What it does

The agent evaluates the working complaint record against your rule catalogue—required acknowledgments and response windows, prescribed disclosures and communications, escalation/approval steps, retention requirements, and any regulator or ombuds filing triggers—and returns a clear pass/flag outcome with rationale and evidence links. When a filing is required, it assembles a regulator-ready packet from approved templates and normalized case data, populates the narrative with verified facts, and routes it to the correct channel for submission/approval. It tracks statutory timelines and acknowledgments, logs each step, and generates targeted prompts for missing items so owners can close gaps quickly.

Core AI functions

Policy/rule evaluation over normalized case, customer, and document data; checklist generation with explicit reason codes; deadline and dependency tracking; template-driven document assembly that pulls only verified fields; cross-record consistency checks to prevent stale or conflicting information in filings; and full lineage from each statement in the packet back to its source page or record.

Problem solved

Regulatory steps are applied inconsistently, filings are assembled ad hoc, and evidence sits across systems—leading to late or incomplete submissions, rework, and audit findings.

Business impact

Complaint handling becomes complete, timely, and defensible. Exceptions drop because ask-backs are specific, policy adherence is consistent across products and segments, and audit posture strengthens through end-to-end traceability of what was checked, filed, and when.

Integration and adjacent use cases

Integration complexity: Low to medium. The agent reads case data and verified artefacts from your servicing/complaints workflow and DMS, writes pass/flag outcomes, checklists, and filing packets back to the same flow, and records acknowledgments—no core changes required.

It is commonly combined with:

• KYC periodic review validator (insurance) to confirm refresh scope and evidence during the case,

• Transactional behavior risk analyzer (complaints) to incorporate objective activity context into rule outcomes, and

• SAR draft generator (insurance) to accelerate the required narrative when thresholds are met.