AI Agents

Context

Built for insurance in the Complaint & dispute stack, this agent is used when a policyholder dispute references recent transactions or servicing activity and the team needs an objective, time-bound view of the surrounding behavior. Typical scenarios include billing and premium disputes, claim-related payment disputes, repeated complaints involving the same counterparties or channels, and regulator-timed cases where reviewers must evidence how behavior changed around the incident.

What it does

The agent analyzes account and policy activity in the period leading up to—and immediately after—the disputed event, then highlights patterns that matter for resolution. It profiles velocity and value changes, repeated counterparties, channel shifts, and timing anomalies, comparing them against the customer’s baseline and relevant peers. Findings are returned as a concise rationale tied to the underlying records, so handlers can see what changed, when it changed, and why it’s relevant to the complaint outcome.

Core AI functions

Per-policyholder baselining and peer cohorting define “normal” behavior; time-window analysis focuses on activity directly linked to the complaint; anomaly detection surfaces sustained or abrupt deviations; and feature construction captures frequency, amounts, counterparty repetition, geography, and channel use. A reason-code layer translates patterns into plain-language statements with links back to the specific transactions or events that triggered them.

Problem solved

Complaint handling often slows down because teams must manually reconstruct context from multiple systems. Relevant behavior around the disputed item is missed or discovered late, creating rework, uneven outcomes, and weak evidencing for audits or regulators.

Business impact

Cases move faster with clearer, more consistent rationales; reviewers focus on material signals instead of re-creating timelines; and audit readiness improves because each conclusion is backed by traceable evidence. The result is fewer missed steps, lower remediation effort, and more defensible resolutions.

Integration and adjacent use cases

Integration is light–moderate: the agent reads recent transactions, servicing events, and policy context from your core or data warehouse and writes findings plus reason codes into your complaint/dispute workflow; no core replacement is required. Insurers commonly combine it with

• KYC periodic review validator to confirm refresh status when the case triggers checks,

• Regulatory rule compliance & filing to ensure mandated steps and filings are executed, and

• SAR draft generator to accelerate mandated summaries if thresholds are met.