Insurance Claims
AI Insurance Claims Operations Platform
ACL leaks 0 · smoke_m10 PASS
FNOL intake, OCR/multimodal, policy RAG, fraud/coverage agents, HITL, and settlement assist.
M0–M10 complete · API 1.0.0
The problem
Claims teams drown in FNOL sprawl, document lag, SLA pressure, and fragmented CMS tools.
FNOL sprawl
Intake fragmented across channels.
Document lag
OCR/multimodal backlog delays decisions.
Ungoverned AI
Auto-deny or invented policy clauses.
ACL leaks
Wrong roles see claim data.
Silent writes
CMS updates without audit.
The solution
FastAPI owns coverage/fraud/HITL/ACL; n8n owns intake/notify — denials and settlements stay gated.
Governed claims AI for FNOL through settlement — no auto-deny chatbot, with ACL and approval compliance.
FNOL intake
Structured first notice with SLA tracking.
OCR + multimodal
Document intelligence into claim file.
Policy RAG
Grounded coverage answers.
Fraud/coverage + HITL
MCP agents with approval on settlements.
ACL + analyst UI
Role-bound claim access and ops views.
FNOL/docs → OCR → FastAPI policy RAG/fraud/HITL → Postgres/Qdrant → CMS stubs → /ops/ui
Before → After
Architecture
Delivery
Milestone narrative from kickoff through closeout — all gates met.
| ID | Theme | Unlocked |
|---|---|---|
| M0–M1 | Architecture + skeleton | Compose stack, schema, FastAPI, n8n, health |
| M2–M3 | Core intelligence | Orchestrator/agents, RAG, primary integrations |
| M4–M5 | Reliability + HITL | Approvals, DLQ, audit, Phase 1 gate |
| M6–M7 | Depth + Phase 2 | Secondary channels/agents, Phase 2 regression |
| M8–M9 | Dashboard + scale | Ops UI RBAC, eval, observability, adapters |
| M10 | Closeout | Docs, UAT/smoke, KT pack, deliverables |
Proof
Verified on local Docker dry-run — no invented client metrics.
smoke_m10
PASS
Closeout
Unauthorized
0
AuthZ
Approval
100%
Settlements gated
ACL leaks
0
Claim ACL enforced
Stack
- FastAPI
- n8n
- Postgres
- Redis
- Qdrant
- OCR
- HITL
- Caddy
Want a system like this?
We build production AI ops platforms — multi-agent orchestration, RAG, CRM, and reliable automation — not one-off chatbot demos.