The problem
Late invoices and reopen requests on closed claims land in general queues, and staff dig through old files to check what was paid.
What changes
- Requests matched to the right closed claim
- Additional amounts checked against prior payments
- Complex reopenings routed to adjusters
Full specification
The complete specification for Complex Claim Reopening & Supplement Agent is shared with your team under NDA as part of a demo or evaluation. It covers:
- Step-by-step workflow and human approval points
- Tools, systems and access levels
- Guardrails and regulatory mapping
- Handoffs to other agents and teams
- Evaluation set (L1–L5) and results
- Model risk documentation