Digital Twin Insurance Agent - Claim Automation using Agentic AI

The Digital Twin Insurance Agent offers below capabilities out-of-box via a conversational Chabot

1.Ingest the claim letters through various channels – postal mail, e-mail and other channels.

2.Identifies and classifies the claims into sensitive and non-sensitive category and notifies the claim adjuster for sensitive claims.

3.Intelligent Routing - Route the claim to adjuster based on expertise (home, health), claim amount (senior, junior adjuster).

4.Entity Extraction – Extract key entities from the claim letter such as claim date, claim amount, court details and so on.

5.Claim Validation – Validate the claim data with the backend system.

6.Enhance Productivity of the Claim Adjuster

7.Dashboard depicting the total number of claims – resolved vs unresolved, sensitive claims, claim adjusted load and other customizable metrics

8.Integration – The solution can be integrated with any claim management solution with minimal effort.

Solution architecture details:

• The breakthrough solution goes beyond LLM automation and leverages Agentic AI architecture built using Amazon Bedrock Agents (Bedrock Multi Agent Framework)

• Responsible AI features enabled

• Highly secure and built using AWS Well Architected framework

Benefits:

• Reduction in claim processing time from days to hours

• Accurate identification and resolution of sensitive claims leading to effort saving

• Accurate routing based on business logic reducing re-work

• Improve claim adjuster productivity by automating effort to summarize, validate, prepare and send response.

• Reduce effort in claim validation and automated fraud detection analysis.