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How to build a Claims Processing Assistant
Accelerate your claims processing workflow. This agent reviews submitted claims, validates policy details, checks for fraud indicators, and categorizes claims for faster resolution by human adjusters.
Challenge
Accelerate your claims processing workflow. This agent reviews submitted claims, validates policy details, checks for fraud indicators, and categorizes claims for faster resolution by human adjusters.
Industry
Insurance
Department
Legal • Compliance
Integrations
SharepointAnthropic
This intelligent workflow transforms your process by automating the most labor-intensive aspects. Here's how it works:
1. Claim Submission & OCR The agent receives claim forms and supporting documents (photos, receipts), using OCR to extract all relevant text and data.
2. Policy Validation Extracted data is automatically cross-referenced with the customer's insurance policy in SharePoint to verify coverage and limits.
3. Fraud Indicator Check AI analyzes the claim for common fraud patterns, inconsistent data, or duplicate submissions, flagging suspicious cases for human review.
4. Categorization & Routing Valid claims are categorized by severity and type, then routed to the appropriate adjuster for final approval.
Key Benefits:
- Reduce claim processing time by 65%
- Improve fraud detection accuracy
- Standardize claim validation process
- Enhance customer satisfaction with faster payouts