Set Up the Claim Triage Agent Module

Prepare for setup

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.

System prerequisites

Your environment must meet the following requirements before you set up the Claim Triage Agent module:

• Appian platform running version 26.9 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 Management Base Application v2.1, which includes the following application containers:
  • Connected Claims Management Base (CCM)
  • CCM Studio Generated Objects
• Imported CCM Add-on: Category Automobile Application v1.2.
• Imported Claim Triage Agent module application container:
  • CCM Add On: Claim Triage Agent (CCM_CTA)

Add the deployment user to the CCM Design Administrator Group

For the Claim Triage Agent to operate, the Deployment Administrator who deployed the CCM Add On: Claim Triage Agent application must be added to the CCM Design Administrator Group. This section is mandatory before you configure the Claim Triage Agent, because it grants the necessary permissions.

To add the Deployment Administrator:

1. In the target environment, sign 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.
4. Click Add Members.
5. Select and add the user who deployed the CCM Add On: Claim Triage Agent application.
6. Click ADD.

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 references these uploaded files to review the rules, understand the team structures, and determine the team to assign each claim to based on your company's guidelines.

To upload the required documents:

1. From Appian Designer, go 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. See 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 the NEW > Document and Create Document steps to upload the team structure document and the list of vehicle inspection agencies document to the same folder.

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, go to the CCM Add On: Claim Triage Agent application.

2. Click NEW > Group.

   

3. Enter a Name and Description for the team. Common team names include:
   • Credit Hire Team
   • Personal Injury Team
   • Property Damage Team
   • Total Loss Team
4. Set the Group Type to Manual (or your organization's preferred group type).
5. Set the Parent Group to CCM Business Group.
6. Add the required users or sub-groups who must receive tasks under that team.
7. Save and publish the group.
8. Repeat the NEW > Group steps for each operational team in your organization.

Update the team mapping lookup table

The Claim Triage Agent routes each claim by using the team names in the CCM_CTA_CLAIM_TEAM_MAPPING_LOOKUP table in the Cloud Database. After you create the operational team groups, update the TEAM column of this table for each new team.

To update the team mapping lookup table:

1. Sign in to the target environment and go to the Cloud Database.
2. Select Appian, then search for and select CCM_CTA_CLAIM_TEAM_MAPPING_LOOKUP.

3. Run the following query to update the TEAM column for the newly created team group. Replace the <team name> placeholder text with the actual team name and <id to be updated> with the MAPPING_ID of the row to update:

   Note:  Update both the TEAM and MAPPING_ID values in the query.

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

   

   

Update the Claim Triage Agent Response record fields

The CCM_CTA_Claim_Triage_Agent_Response record type stores one field for each team. After you update the CCM_CTA_CLAIM_TEAM_MAPPING_LOOKUP table, update the matching field name in CCM_CTA_Claim_Triage_Agent_Response in the same way.

To update the record fields:

1. In Appian Designer, open the CCM Add On: Claim Triage Agent application.
2. Search for and open the CCM_CTA_Claim_Triage_Agent_Response record type.

3. Go to the Data Model tab.

   

4. Click the Blue Edit icon associated with the team1 field name.
5. Update the Record Field Name and Display Name in CCM_CTA_Claim_Triage_Agent_Response to match the team name that you updated in the CCM_CTA_CLAIM_TEAM_MAPPING_LOOKUP table for Team 1.
6. Click OK.

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, go 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.

Update expression rules

You must update four expression rules in the Connected Claims Management Base application to integrate the Claim Triage Agent with Connected Claims.

Update CCM_AUTO_EVAL_AvailableFieldsCustomizations

1. In Appian Designer, go 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:

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   rule!CCM_CTA_AUTO_EVAL_AvailableFieldCustomizations_ClaimTriageAgent()
   

   

4. Click SAVE.

Update CCM_Task_SetEvents

1. In the Connected Claims Management Base application, search for and open the CCM_Task_SetEvents expression rule.

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

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   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. In the Connected Claims Management Base application, 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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   equals: cons!CCM_CTA_REFID_TASK_BEHAVIOR_TYPE_EXECUTE_AGENT,
   then: {
     rule!CCM_CTA_ExecuteAgentTaskType_selectionField(referenceTask: ri!referenceTask)
   }
   

   

3. Click SAVE.

Update CCM_FieldValuePairToFilterAutomationTask

1. In the Connected Claims Management Base application, search for and open the CCM_FieldValuePairToFilterAutomationTask expression rule.

2. Add the following code:

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   cons!CCM_CTA_REFID_TASK_BEHAVIOR_TYPE_EXECUTE_AGENT
   

   

3. Click SAVE.

Configure the Task Complete process model

Update the CCM_Task_Complete_AutomatedTask_Wrapper process model so it triggers the Claim Triage Agent when a user completes an Execute Agent task.

To configure the process model:

1. In Appian Designer, go 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, Trigger Agent, after the Dummy Node for Incorp node.

   

4. Configure the setup and input variables of the Trigger Agent subprocess, as shown:

   • Process Model: CCM CTA Run Agent

     

5. Save and publish.

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 following expression rules.

To configure the relationships:

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

3. In line 2, configure the local!claimTriageAgentReleationship local variable with the CCM_Claim.claimTriageAgentResponse relationship, as shown:

   

4. Click SAVE.
5. Search for and open the CCM_getClaimForAutomationEvalution expression rule.

6. In the recordTypesToInclude parameter, add the CCM_Claim.claimTriageAgentResponse relationship along with the other relationships, as shown:

   

7. Click SAVE.

Set up the workflow

This section creates the Execute Agent task and the team-specific tasks, and configures the claim type 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, sign in as a user with appropriate permissions.
2. Open the Control Panel.

3. Go 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. After 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 Control Panel, go 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 the CREATE TASK steps to create tasks for all other teams.

Configure Workflow

The basic workflow for the Claim Triage Agent follows 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 more tasks to this basic workflow based on your requirements.

To create and configure the workflow:

1. In the target environment, sign in as a user with appropriate permissions.
2. Open the Control Panel.

3. Go to the corresponding claim type by selecting the claim category, then the claim type.

   

4. Select the Workflow tab.

5. Click CONFIGURE WORKFLOW if no workflow is configured for the claim type. Otherwise, click Update Workflow to edit the existing workflow.

   

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

7. Click ADD AUTOMATION to create an automation task, then define a rule for each team so that the workflow routes the claim to that team's task according to the Triage Agent output. For example:

   When this team field is true	Go to
   Team1	Credit Hire Team Analysis
   Team2	Personal Injury Team Analysis
   Team3	Accidental Team Analysis
   Team4	Recovery Team Analysis
   Team5	Total Loss Team Analysis

   For If no rule is met, go to, select End.

   

8. Configure the workflow by following the basic pattern in this section. For more information on creating workflows, see Workflow Tutorial.

Use the agent after setup

After you set up the Claim Triage Agent module, the agent automatically analyzes new claims and routes them to the appropriate teams based on your organization's business rules and team structure. The agent records its decisions and reasoning as comments on each claim for review and validation.

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