Insurance
Claims review, fraud screening, and regulatory reporting all depend on being able to show, after the fact, exactly what was checked, by whom, and on what basis a claim was escalated or settled. This page sets out how such a workflow would be planned and run on inTheEU Assist, not a record of a completed deployment.
How the workflow would be structured
A claim file would be ingested into a case-scoped knowledge pack, with an agent configured to extract relevant facts, cross-reference policy terms, and propose a risk or fraud flag where the pattern warrants it. Each proposed flag is entered with a status of proposed, tied to the specific claim and the documents it was drawn from, and never applied automatically to the claim's status.
A proposed escalation, denial, or referral for investigation would be planned as a sequence of stages, hashed before execution, so the reasoning an adjuster or reviewer approves is exactly what the record shows was carried out.
Where human approval sits
A flagged claim would move from proposed to reviewed to approved or rejected. Nothing reaches a customer-facing decision, a settlement, or a regulatory filing until the responsible adjuster or compliance officer has signed off on it. That sign-off, and the specific claim data it was checked against, would be independently verifiable afterwards.
What this draws on today, and what it does not
Case-scoped document ingestion, the proposed-to-approved review lifecycle, and the signed audit chain tying a flag or decision back to its source claim and its reviewer are working parts of the platform. What is not part of this: any pre-built fraud-detection model or actuarial judgement. The insurer's own adjusters and compliance teams remain the authority on what constitutes a valid flag; the platform makes their review provable and traceable to the claim file it was based on.
Some of the architecture underlying this capability set is documented in filings still in progress. This page describes what the platform is designed to do, at a level appropriate for planning a pilot, not an implementation specification.
Platform features and interface are subject to continuous improvement. Descriptions in this guide may not reflect the exact layout or wording of the latest released version.