Claim Triage Agent Module Overview

What the Claim Triage Agent module does

Connected Claims ships with the Claim Triage Agent module, a pre-built, self-contained application that leverages Appian's AI agents to perform an initial assessment of claims and route them to the correct team for review. By incorporating this module with your Connected Claims Base application, you can automate the complex task of claim triaging that requires manual review across multiple systems, reducing processing time and improving accuracy.

This page provides a brief overview of the features and benefits of the Claim Triage Agent module and how it can help streamline your Connected Claims workflow.

AI-powered claim routing and team assignment

After the Claim Triage Agent module is incorporated with Connected Claims, the module is designed to automatically analyze claim details and determine which internal teams should handle each claim based on your organization's business rules and team structure.

This module incorporates AI agent capabilities into the Connected Claims workflow and uses Appian's AI agents to:

• Fetch and analyze claim details including loss descriptions, vehicle information, and policy coverage.
• Apply your organization's specific business rules and team structure.
• Determine which teams should be involved in processing the claim.

• Provide reasoning for each team assignment decision.

  

The Claim Triage Agent can identify multiple teams that may need to be involved in processing a claim, including:

• Accidental Damage Team (always assigned)
• Subrogation Team
• Total Loss Team
• Credit Hire Team
• Personal Injury Team

The agent's response, along with the reasoning for each decision, is automatically noted as comments on the claim for human validation and review.

Key benefits of the Claim Triage Agent module

• Automated decision-making: Eliminates the manual process of reviewing claims across multiple systems
• Improved accuracy: Reduces the risk of missing important data points that a human reviewer might overlook
• Faster processing: Significantly reduces the time required to triage and route claims
• Consistent application: Ensures business rules are applied consistently across all claims
• Audit trail: Maintains a clear record of routing decisions and reasoning

Install and set up the Claim Triage Agent module

Ready to automate your claim triaging process and improve efficiency? Download and install the Claim Triage Agent module with Connected Claims to unlock the power of AI-driven claim routing.

After installing the module, follow the setup steps to incorporate the Claim Triage Agent module with Connected Claims.

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