TCS Agentic Claims Processing Solution: ClaimXpert

ClaimXpert: TCS's Agentic AI Platform for Autonomous Claims Handling   ClaimXpert is TCS's AI-native platform that redefines insurance claims-from a linear process into an intelligent, agent-driven ecosystem. Designed ground-up for Agentic AI, it orchestrates complex workflows, drives expert-level decisioning, and integrates deeply with enterprise systems, moving beyond traditional RPA or rules-based automation.   Built on AWS Bedrock Agents, at its core, ClaimXpert leverages a network of specialist agents-some powered by fine-tuned LLMs trained on insurance datasets, NAIC regulations etc. These agents reason across unstructured and structured inputs, invoke external tools, and make nuanced decisions that reflect domain expertise. The Bedrock agents leverage AWS OpenSearch for knowledge source retrievals and AWS Lambda to perform actions. The LLMs are governed leveraging various services offered by AWS like the X-Ray, GuardDuty, IAM and CloudWatch for monitoring and audits. This ensures accuracy and consistency in agent responses. The Bedrock agent framework ensures quick and easy configuration of agents along with guardrail integrations.

ClaimXpert exemplifies an enterprise-grade use case for Agentic AI: 

• Nuanced decision making: Goes beyond binary decisions, agents infer context, flag inconsistencies and adjudicate based on multi source evidence ( images, documents, structured data )
• Tool using agents: Agents interact with external tools leveraging protocols like MCP ( eg: claim system utilities, geolocation apis, repair databases etc ) .
• Multi agent collaboration: Modular agents work in sequence and in parallel – extracting data, NIGO checks, triaging, evaluating, escalating – across lifecycle from intake to adjudication.   **Use cases configured: **
• Workers Compensation & Disability LOBs:
• Data extraction from various sources ( doctors notes, employment letter, claim forms etc ) . Agents reason across these information to arrive at compensability decision. Supports specialist agents ( with fine tuned models ) that supports compliance evaluation based on state specific and NAIC rules and legal precedents.
• Auto FNOL with contact center integration
• Live audio transcript generation with real time agent support.
• Agents dynamically fill FNOL forms during call.
• Real time liability validation aiding the contact center to ask the right questions.
• Data enrichment (geo data, traffic etc)
• Auto adjudication pipeline
• Document & image ingestion : police reports, garage bills, photos
• Data extraction agents : Identifies entities, damage areas, timelines
• NIGO agents: validate document completeness and vehicle match
• Evaluator agents : cross verify damage descriptions vs images
• Anomaly detector : flags inconsistencies ( eg: damage claimed not matching narrative)

Business Impact anticipated

•  50%+ reduction in reserve leakage
• 80% faster litigation risk identification
• Enhanced compliance and auditability
• Adjuster roles transformed from reactive to strategic