Enterprise AI-Driven Claim Approval Agent

Pay fast, or investigate hard

Claims sit between two opposing pressures — pay legitimate claims quickly, and rigorously catch fraud. Manual review does one or the other, never both. This agent does both, through a six-stage pipeline where nothing advances on unchecked data.

The six stages

▸1 · Intake — email, portal and API claims normalized into one object with an idempotency token; nothing processed twice.

▸2 · Hygiene — malware scan and EXIF-strip before any model runs.

▸3 · Assessment — Vision OCR, damage detection and authenticity checks, in parallel.

▸4 · Scoring — a multi-factor engine produces a severity and fraud-risk profile.

▸5 · Decision — routes to Proceed, Inspect or SIU Fraud, with a plain-language reason for every factor.

▸6 · Audit — every score, decision and human touch to an immutable log.

Explainable by design

Because the decision engine explains itself, adjusters trust it and regulators can follow it — legitimate claimants get faster answers, high-risk claims get scrutiny, and every call is defensible.