Insurance Claims Adjudication Agent

Insurance Claims Adjudication Agent

An intelligent multi-agent framework built to ingest, cross-reference, and validate medical or generic insurance claims against dense policy boundaries to detect anomalies and automate approvals.

✨Features

• Multi-agent task breakdown distributing claim ingestion, policy matching, and fraud check responsibilities
• Deterministic execution routing ensuring absolute compliance with structural claim rules
• Human-in-the-loop validation checkpoints for edge-case billing codes and high-value claim exceptions
• Structured Pydantic outputs optimizing downstream database logging and claims processing speed