AI-Assisted Claims Processing
An AI agent that reads claims and prepares them for human review — with explicit limits on what it decides.
- Client
- Financial services provider
- Sector
- Finance
- Year
- 2026
Challenge
Claims arrived as unstructured documents, and reviewers spent most of their time extracting data rather than assessing it. Any automation had to be fully auditable by regulation.
Solution
We built a pipeline that extracts fields from the document, reconciles them against existing records, and presents the reviewer with a summary showing the source of every field. The model never approves or rejects — it only prepares. Every inference links back to the passage it came from.
Impact
Reviewer time moved from extraction to judgement, and the final decision stayed human and fully documented.
Results
- Illustrative
- Review time
- Illustrative
- Extraction accuracy
- Complete
- Auditability
How we delivered it
- 01
Assess
One measurable use case selected instead of automating everything at once.
- 02
Pipeline
Structured extraction with every field linked to its source in the document.
- 03
Guardrails
Explicit definition of what the model decides and what stays human.
- 04
Evaluation
Weekly extraction-accuracy measurement and drift monitoring.
Technology
- Python
- Claude API
- PostgreSQL
- Vector database
- Airflow
- Azure
Let's Talk
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