Healthcare

Claims first-notice and triage

Capture, check, and route every claim, fast

A claims agent that takes in first notice of loss from any channel, extracts the key facts, checks them against policy and rules, and routes each claim to the right place with a priority and a summary. Complex and high-value claims reach an adjuster ready to act.

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The problem

Claims arrive as forms, emails, photos, and PDFs across every channel, and intake is still mostly manual. Slow first-notice handling frustrates customers and lets complex or high-value claims sit in a queue. Inconsistent triage means similar claims get handled in very different ways.

The outcome

40%

faster claims triage

The architecture

How the work actually flows

No black box. This is the real data and agent flow, from the moment work arrives to the moment it is done, with a human in the loop wherever the stakes are high.

Intake

Receive first notice of loss from web forms, email, and documents, and assemble it into one claim record.
Extract

Pull the key facts from forms and evidence: parties, dates, loss type, amounts, and policy number.
Verify

Check the claim against the policy, coverage rules, and duplicate or fraud signals.
Triage

Assign a severity and priority, and decide the right path: fast-track, standard, or specialist review.
Route

Send each claim to the correct queue or adjuster with a summary and the supporting evidence attached.
Audit

Log every decision and the reasoning so the whole triage path is reviewable and consistent.