Insurance Claims AI Agent Team — 12-Agent Claims Operation

AutomatedAgents • onboard-insurance-claims.sh • Core Pipeline + 4 Satellites

📞 FNOL Call Center Phone • Agent • Walk-in 🌐 Digital FNOL Web • Mobile • Email • Portal ⚙️ CLAIMS MANAGER Chief Claims Officer • Reserve Authority • Litigation Gatekeeper • Board Reporting Cron: 6am brief • 7am reserve review • 8am compliance SLA • Sun weekly learning 📥 INTAKE FNOL Processing • All channels capture • Validation & dedupe • Doc collection • Customer comms 🎯 TRIAGE Severity & Routing • Severity scoring • Complexity check • Fraud risk screen • Path assignment 📑 COVERAGE Policy Interpretation • Policy analysis • Coverage opinions • Exclusions & limits • Reservation of rights 🛠️ ADJUSTER Liability & Settlement • Liability assessment • Damage evaluation • Settlement negotiation • Money movement 💰 RESERVES Case & Expense Reserves • Reserve adequacy • Financial reporting • Reinsurance recovery • IBNR analysis 🕵️ FRAUD / SIU Investigations Unit • Structured scoring • External data checks • ISO / NICB queries • SIU escalation ⚖️ COMPLIANCE Regulatory & SLA • Fair Claims Practices • Prompt Payment Laws • Bad faith standards • SLA enforcement 📡 MONITOR 24/7 Surveillance • API health & budget • Regulatory calendar • System availability • Liveness checks SATELLITE STRATEGIES 👨‍⚖️ LITIGATION STRATEGIST Defense strategy • Budgets • Experts Escalates: reserve + litigation triggers 🔁 SUBROGATION Recovery identification & pursuit Target: 25% scale / 30% enterprise 🌪️ CATASTROPHE MODELER NOAA / NHC / USGS / FEMA events CAT event declaration & protocol 📊 ACTUARIAL CO-PILOT Reserve adequacy validator Development factors • Filings INTEGRATIONS & TOOLS Guidewire Claims Mgmt • Policy • Billing ISO ClaimsSearch • Fraud scoring NICB Fraud database • Alerts LexisNexis Data verification • Records CoreLogic Property data • Valuation 🧠 Mnemosyne 📱 Twilio 🌊 FEMA • NOAA • NHC • USGS KEY PERFORMANCE INDICATORS FNOL→closure < 24h • Reserve adequacy > 95% • Compliance SLA 100% • Fraud detection > 20% uplift • Subrogation recovery > 25% • Litigation cost < 15% of claim Legend Orchestrator Core Pipeline Money / Settlement Risk / Finance / Data Risk / SIU Surveillance External Reports to Claims Mgr Data / Integration

How It Works

  • • FNOL comes in on any channel → Intake captures
  • • Triage scores severity, complexity, fraud risk
  • • Coverage produces binding coverage opinions
  • • Adjuster owns claim through settlement
  • • Reserve-Setter books reserves; Fraud runs SIU
  • • Compliance enforces SLA & regulatory standards
  • • Satellites handle litigation, subrogation, CAT, actuarial

Claims Manager

  • • Reserve authority & litigation gatekeeper
  • • Morning brief 6am, reserve review 7am
  • • Compliance SLA enforcement (24h >$100K)
  • • Board reporting & regulatory examinations
  • • CAT event judgment calls
  • • Owns subrogation recovery targets

Deployment

  • • Script: onboard-insurance-claims.sh
  • • 12 agents: 8 core + 4 satellites
  • • 48 scheduled jobs across the team
  • • Each agent gets SOUL.md, config, cron jobs
  • • Integrates: Guidewire, ISO, NICB, LexisNexis
  • • Shared memory via Mnemosyne across all agents