AI in Connected Claims

Connected Claims (CC) applies AI across claim intake, claim research, coverage assessment, and triage so adjusters spend less time reading source material and more time deciding. For a catalog of the AI add-on modules and their install paths, see AI Add-On Modules.

CC AI capabilities

The following AI features are available in Connected Claims (CC). Each one is built so that AI proposes and a person decides, and every output is available for review before it drives a claim decision.

CC AI Chat with Claims

CC places a conversational assistant directly on the Claim Summary view, so adjusters can question a claim without leaving the record. Ask it to recap the history, list the files attached to the claim, or suggest where to begin on work you have just inherited. Two platform pieces sit underneath it, the Records Chat Component paired with Appian AI Copilot, which cuts down on hunting through the record by hand.

For detailed instructions, see Quick data capture and retrieval.

CC AI Claim Comment Summary

CC collapses every comment logged against a claim into one running overview, sparing adjusters from reading each entry in order. That overview refreshes by itself whenever anyone adds, edits, or removes a comment. The result stays accurate as discussion accumulates over the life of the claim.

For detailed instructions, see Leverage Appian AI.

CC AI Claim Document Summary

CC writes a summary for each PDF attached to a claim by way of Appian's Document Summary AI Skill. The upload route makes no difference: files added while the claim is being opened, dropped in later from the document list, or supplied when someone finishes a task all get the same treatment, and the summary stays available at every stage afterward. Removing a document clears its summary too, which helps you meet privacy and retention obligations.

For detailed instructions, see AI-generated summaries for uploaded PDF documents.

CC coverage assessment

Connected Claims (CC) offers two add-on modules that assess policy coverage on a claim. Both modules read the loss description, weigh it against the deductible and coverage terms on the policy, and post a result on the claim summary without the adjuster requesting it. Both also re-evaluate when the loss details change, so the result does not drift out of date. Choose the module that matches how your adjusters work, and review both overviews before you adopt either one:

• AI Coverage Analyzer: Labels the claim Covered, Not Covered, or Further Review Needed at intake. For detailed instructions, see AI-driven coverage status for new claims.
• Claim Coverage Verification AI: Posts a coverage verification status when a claim opens and again on each loss update. Pulling the policy lookup out of intake shortens first assessment and keeps determinations consistent from one adjuster to the next. For detailed instructions, see AI-driven coverage verification for claims.

CC AI Policy Document Assistant

CC condenses uploaded PDF policy documents and lets adjusters interrogate them through a chatbot. Policy wordings run long, and reading one end to end to confirm a single limit or exclusion is slow work, so this module lets you put the question straight to the document and get an answer drawn from its own text. Adjusters can work through a lengthy policy in a fraction of the time manual review would take. Appian AI Copilot supplies both the summary and the conversational answers.

For detailed instructions, see Chat with policy documents.

CC Claim Triage Agent

CC calls on Appian AI agents to read an incoming claim and work out which internal teams should take it. The agent measures loss descriptions, vehicle data, and policy coverage against the rules and team structure you define, and it can name several destinations at once, among them subrogation, total loss, credit hire, and personal injury. Its reasoning for each choice is posted back to the claim as comments, leaving a person to confirm the routing and an audit trail behind it.

For detailed instructions, see AI-powered claim routing and team assignment.

CC AI-assisted claim creation from email

CC lifts claim data out of the body of an inbound email so adjusters do not retype what the sender already wrote. Messages polled from your configured Microsoft inboxes arrive in a triage queue, where AI fills in the claim fields that apply across every line of business and the adjuster decides whether to open a new claim, attach the message to one already on file, or discard it. Values arrive pre-filled rather than committed, so a person still confirms the detail before the claim exists. This capability belongs to the Create Claim via Email module rather than to the seven AI add-on modules above.

For detailed instructions, see Key capabilities.

Configure CC AI features

Every Connected Claims (CC) capability above arrives as its own add-on module, so administrators install the module and then work through its setup page. Install pages are published in both MariaDB and PostgreSQL variants. CC ships only in the advanced and premium capability tiers, and each module page states its own tier and licensing requirements.

• Set Up AI Chat with Claims Module: Surfaces the record chat component on the Claim Summary view.
• Set Up AI Claim Comment Summary Module: Displays the comment summary and wires up comment deletion.
• Set Up AI Claim Document Summary Module: Adds the document summary nodes to your claim processes.
• Set Up the AI Coverage Analyzer Module: Configures the coverage status display on the claim summary.
• Set Up the Policy Document AI Chat Module: Turns on summaries and chat for policy documents.
• Set Up Claim Coverage Verification AI: Enables coverage verification at claim creation and on loss updates.
• Set Up the Claim Triage Agent Module: Creates the operational groups and workflow the agent depends on.
• Set Up Create Claim via Email: Connects the email poller and turns on AI-assisted claim creation from the triage queue.

CC related Appian platform AI resources

Connected Claims (CC) is built on Appian's AI platform. To understand the platform capabilities, governance, and security that support CC AI features, see the following Appian platform AI resources:

• What is Artificial Intelligence?: An introduction to AI concepts and how Appian applies them.
• Appian AI Copilot: The AI assistant available across the Appian platform.
• AI/ML Glossary: Definitions for the AI terms used throughout Appian documentation.

• AI Guardrails: The controls that keep AI outputs safe, accurate, and within policy.

• Responsible AI Statement: Appian's statement on ethical and responsible AI use.
• Security and Compliance: How Appian secures data processed by AI features and meets compliance requirements.
• AI Troubleshooting and Best Practices: Guidance for diagnosing and resolving AI feature issues.

For more detail on how Appian keeps your data private when using AI, see Private AI and AI Services.

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