Automating claims triage with a production AI agent

Challenge

Claims intake was a manual bottleneck, with experienced staff spending most of their time on routine triage instead of complex decisions.

Approach

We built a retrieval-augmented pipeline over historical claims data, paired with an agent that extracts structured fields, flags anomalies, and hands off uncertain cases to a human reviewer.

Implementation

Rolled out to a single claims category first, with full evaluation and guardrails, before expanding coverage.

Outcome

Routine claims are now triaged automatically, with specialists focused on the cases that need judgment.

Technologies