Prioritize adjuster attention where it matters most
Prioritize adjuster attention where it matters most.
High-Complexity Claim Flagged
Auto collision • Litigation indicators detected
Built for claims teams
who catch every pattern
Not every claim is equal. Some are straightforward; others hide complexity that escalates into litigation, fraud, or reserve surprises.
Claims Adjusters
Claim investigation & settlement
Claims Supervisors
Queue management & escalation
SIU Analysts
Fraud detection & investigation
Operations Managers
Operational efficiency & SLAs
From alert to action in minutes
The objective of this agent is to reduce handling time and leakage through early complexity identification.
The Trigger
You define when the agent should activate. When conditions are met, it starts working automatically.
- High reserve threshold: Initial reserve exceeds defined amount (e.g., >$50,000)
- Litigation indicator: Claimant has attorney or claim involves bodily injury
- Fraud signal: Claim matches fraud patterns or scores above model threshold
360° View
The agent opens a tailored dashboard consolidating data from all your systems.
- Claim summary header with claim number, loss date, line of business, status
- Policy details panel showing coverage types, limits, deductibles, exclusions
- Prior claims history for this claimant across policy types with outcomes
Automated Analysis
The agent follows a structured analysis flow, combining checks with exploratory reasoning.
- Coverage verification: Reviews policy terms against loss circumstances, flagging exclusions.
- Claimant history analysis: Examines prior claims, calculating frequency and severity.
- Fraud indicator review: Evaluates fraud scores and matches against known patterns.
Actionable Output
After analysis, the agent creates a human-friendly report with everything your team needs.
- Triage summary: Overview of complexity, concerns, and recommended handling path
- Complexity classification: Handling tier with rationale
- Red flags identified: Specific concerns ranked by severity
Delivery
Reports are sent automatically via email or accessed directly in Veezoo.
Key benefits for operations teams
Concrete, measurable value for your team from day one
Faster time to action
Before: 30-60 minutes gathering history. Now: triage in minutes.
Earlier fraud detection
Surface suspicious patterns at FNOL, reducing fraud losses by 5-10%.
Improved reserve accuracy
Reserves informed by comparable claims reduce volatility.
Up and runningin production in weeks
To deploy this Agent, you connect Veezoo to your existing Data Warehouse, typically containing data from:
Ready to explore Claims Triage Assistant?
Fully customizable to your workflows, data sources, and business requirements.
Typical initial implementation in weeks, not months.