Set Up the Claim Triage Agent Module

Set up the Claim Triage Agent module

After installing the Claim Triage Agent module, you need to set it up before using it with the Connected Claims Base application.

This guide walks you through the setup steps, which include:

1. Add the deployment user to the CCM Design Administrator Group.
2. Upload required documents.
3. Create groups for operational teams.
4. Configure the Connected Claims Claim record type reference.
5. Update expression rules.
6. Configure the Task Complete process model.
7. Configure the Claim Triage Agent Response relationship.
8. Set up the workflow.

System prerequisites

Before setting up the Claim Triage Agent module, ensure your environment meets the following requirements:

• Appian platform running version 25.4 or greater.
• AI agents enabled in your Appian Cloud environment. AI agents are available in select regions. For cloud customers, your site must be migrated to Stratus infrastructure to use AI agents.
• A supported web browser.
• Imported Connected Claims Base application version 1.2.1 or higher, which includes the following application containers:
  • Connected Claims Management Base (CCM)
  • CCM Studio Generated Objects
• Imported CCM Add-on: Category Automobile Application version 1.1 or higher.
• Imported Claim Triage Agent module application container:
  • CCM Add On: Claim Triage Agent (CCM_CTA)

Step 1: Adding the deployment user to the CCM Design Administrator Group

To ensure the successful operation of the AI Agent, the Deployment Administrator who deployed the CCM Add On: Claim Triage Agent application must be added to the CCM Design Administrator Group. This step is mandatory before configuring the Claim Triage Agent, as it grants the necessary permissions.

To add the Deployment Administrator:

1. In the target environment, log in as a user with appropriate permissions.
2. In Appian Designer, go to the Connected Claims Management Base application.
3. Search for and open the CCM Design Administrator Group.
   1. Click Add Members.
   2. Select and add the user who deployed the CCM Add On: Claim Triage Agent application.
   3. Click ADD.

Step 2: Upload required documents

As part of setting up the Claim Triage Agent, upload the following documents to the source folder. These documents must reflect the specific team classifications, decision rules, and assignment conditions defined by your insurance company:

• Business rules document
• Team structure document
• List of vehicle inspection agencies document

The Claim Triage Agent will reference these uploaded files to review the rules, understand the various team structures, and accurately determine the appropriate team to which each claim should be assigned based on your company's guidelines.

To upload the required documents:

1. From Appian Designer, navigate to the CCM Add On: Claim Triage Agent application.
2. Search for and open the CCM_CTA_Claim_Triage_Source_Files folder.

3. Click NEW and choose Document.

   

4. Upload the business rules document.

   Note:  The document format must be PDF only. Refer to the sample documents CCM_CTA Business_Rules_Document and CCM_CTA Team_Structure_Document included in the application for guidance on document creation.

5. Click Create Document.
6. Repeat steps 3-5 to upload the team structure document and list of agencies document to the same folder.

Step 3: Create groups for operational teams

The Claim Triage Agent relies on Appian groups to manage task assignments, access control, and routing to the appropriate operational teams. Before configuring the agent, you must create the required user groups that represent each claims handling team within your organization.

To create operational team groups:

1. From Appian Designer, navigate to the CCM Add On: Claim Triage Agent application.

2. Click NEW > Group.

   

   1. Enter a Name and Description for the team. Common team names include:
      • Credit Hire Team
      • Personal Injury Team
      • Property Damage Team
      • Total Loss Team
   2. Set the Group Type to Custom (or your organization's preferred group type).
   3. Set the Parent Group to CCM Business Group.
      1. Add the required users or sub-groups who should receive tasks under that team.
      2. Save and publish the group.
3. Repeat steps 2-7 for each operational team in your organization.
4. After creating all teams, log in to the target environment and navigate to the Cloud Database.
5. Select Appian, then search for and select CCM_CTA_CLAIM_TEAM_MAPPING_LOOKUP.

   1. Execute the following query to update the TEAM column for the newly created team group by replacing the <team name here> placeholder text with the actual team name.

      Note:  Ensure that the values for TEAM and MAPPING_ID are updated accordingly.

      1
      UPDATE `CCM_CTA_CLAIM_TEAM_MAPPING_LOOKUP` SET `TEAM` = '<team name>' WHERE `CCM_CTA_CLAIM_TEAM_MAPPING_LOOKUP`.`MAPPING_ID` = <id to be updated>;
      

      

6. Navigate back to Appian Designer and open CCM Add On: Claim Triage Agent application.
7. Search for and open the CCM_CTA_Claim_Triage_Agent_Response record.
   1. Click the Blue Edit icon associated with the team1 field name.
   2. Update the Record Field Name and Display Name in CCM_CTA_Claim_Triage_Agent_Response to match the team name that was updated in the CCM_CTA_CLAIM_TEAM_MAPPING_LOOKUP table for the Team 1.
   3. Click OK.

Step 4: Configure the Connected Claims Claim record type reference

The Claim Triage Agent stores its analysis and recommendations as responses linked to each claim. To enable this functionality, you must add a relationship between the CCM_Claim record type and the CCM_CTA_Claim_Triage_Agent_Response record type.

To configure the record type reference:

1. In Appian Designer, navigate to the Connected Claims Management Base application.
2. Search for and open the CCM_Claim record type.
3. Click Add Relationship.
4. Configure the relationship with the following settings:
   • Related Record Type: CCM_CTA_Claim_Triage_Agent_Response
   • Relationship Name: claimTriageAgentResponse
   • Relation Type: One to Many
   • Column: claimId

   

5. Click SAVE.

Step 5: Update expression rules

You need to update several expression rules to integrate the Claim Triage Agent functionality with Connected Claims.

Update CCM_AUTO_EVAL_AvailableFieldsCustomizations

1. In Appian Designer, navigate to the Connected Claims Management Base application.
2. Search for and open the CCM_AUTO_EVAL_AvailableFieldsCustomizations expression rule.

3. Add the following code to the expression rule:

   1
   rule!CCM_CTA_AUTO_EVAL_AvailableFieldCustomizations_ClaimTriageAgent()
   

   

4. Click SAVE.

Update CCM_Task_SetEvents

1. Search for and open the CCM_Task_SetEvents expression rule.

2. Add the following code to the appropriate location in the expression rule:

   1
   2
   3
   4
   5
   tostring(
     fv!item['recordType!{ee5aa46d-0228-430f-a794-1134a11fbcc0-ccm}CCM_Task.relationships.{62b2fade-95e2-40da-b612-4de6010fbfee-ccm}comments.fields.{9f09c4b8-5fc5-4a38-bf9d-e7641844b80f-ccm}createdBy']
   ) = tostring(
     cons!CCM_CTA_USER_AGENT_SERVICE_ACCOUNT
   )
   

   

3. Click SAVE.

Update CCM_ReferenceTask_Sub_TaskBehaviorTypeCreateDynamicDisplay

1. Search for and open the CCM_ReferenceTask_Sub_TaskBehaviorTypeCreateDynamicDisplay expression rule.

2. Add the following code in the local!eventTypeId - a!match condition:

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   2
   3
   4
   equals: cons!CCM_CTA_REFID_TASK_BEHAVIOR_TYPE_EXECUTE_AGENT,
   then: {
     rule!CCM_CTA_ExecuteAgentTaskType_selectionField(referenceTask: ri!referenceTask)
   }
   

   

3. Click SAVE.

Update CCM_getAutomatedTasks

1. Search for and open the CCM_getAutomatedTasks expression rule.

2. Add the following code:

   1
   cons!CCM_CTA_REFID_TASK_BEHAVIOR_TYPE_EXECUTE_AGENT
   

   

3. Click SAVE.

Step 6: Configure the Task Complete process model

The Task Complete process model must be updated to trigger the Claim Triage Agent when an Execute Agent task is completed.

To configure the process model:

1. In Appian Designer, navigate to the Connected Claims Management Base application.
2. Search for and open the CCM_Task_Complete_AutomatedTask_Wrapper process model.

3. Insert a Synchronous Subprocess node named Trigger Agent.

   

4. Configure the subprocess node with the following settings:
   • Process Model: CCM CTA Run Agent

   • Map the required input variables from the parent process to the subprocess.

     

5. Save and publish.

Step 7: Configure the Claim Triage Agent Response relationship

To enable the Claim Triage Agent response to display in the claim evaluation, you need to configure the relationship in the appropriate expression rule.

To configure the relationship:

1. In Appian Designer, navigate to the Connected Claims Management Base application.
2. Search for and open the CCM_CTA_AUTO_EVAL_AvailableFieldCustomizations_ClaimTriageAgent expression rule.

3. In line 4, remove the comment markers and update the relationship parameter to: relationship: CCM_Claim.claimTriageAgentResponse.

   

4. Click SAVE.

Step 8: Set up the workflow

The final step is to create the necessary tasks and configure the workflow to use the Claim Triage Agent.

Create Execute Agent Task

The Execute Agent Task is an automated task that triggers the Claim Triage Agent.

To create the Execute Agent Task:

1. In the target environment, log in as a user with appropriate permissions.
2. Navigate to the Claims Studio site.
3. Navigate to the Tasking tab and click Tasks.
4. Click the CREATE TASK record action to create a new task.
5. Select Task Type as Execute Agent.
6. In the dropdown, select Claim Triage Agent.
7. Click CREATE.

Create team specific tasks

Team-specific tasks are attended tasks that you must create for each team. Once the agent determines the appropriate team based on the business rules, the workflow automatically routes and assigns the claim to the corresponding team's task for further processing.

To create team-specific tasks:

1. In the Claims Studio site, navigate to the Tasking tab and click Tasks.
2. Click CREATE TASK.
   1. Enter values in the following fields: a. Name b. Task Type c. Default Assigned Group
      • Note: Select the group for which you created the task.
   2. Click CREATE.
3. Repeat step 2 to create tasks for all other teams.

Configure Workflow

The basic workflow for the Triage Agent should follow this pattern:

Start → Triage Agent Task → Automation Task

Configure the Triage Agent workflow to route tasks to specific teams based on the agent's output.

You can add additional tasks to this basic workflow based on user requirements.

To create and configure the workflow:

1. In the target environment, log in as a user with appropriate permissions.
2. Navigate to the Claims Studio site.
3. Under Claim Types, select the corresponding claim type.
4. Select the Workflow tab.

5. Click CONFIGURE WORKFLOW if no workflow is configured for the claim type, or edit the existing workflow.

   

6. In the Configure Workflow screen, add the agent task and the team-specific tasks using Add Task.

7. Create an automation task and define rules to route and assign tasks to the relevant teams according to the Triage Agent output.

   

8. Configure the workflow following the basic pattern mentioned above.
   • For more information on creating workflows, see Workflow Tutorial.

Next steps

Now that you have set up the Claim Triage Agent module, the agent will automatically analyze new claims and route them to the appropriate teams based on your organization's business rules and team structure. The agent's decisions and reasoning will be recorded as comments on each claim for review and validation.

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