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Claims intake is the bottleneck of the entire claims lifecycle. Every new submission arrives as a mix of forms, documents, emails, and attachments that a human adjuster must read, extract key details from, enter into the system, classify, and route. This process typically takes 30-60 minutes per claim. With hundreds of new claims per day, the backlog grows faster than the team can process it — and every hour of delay frustrates the policyholder. This use case deploys an event-triggered playbook that processes new claim submissions the moment they arrive. The system extracts policy numbers, loss details, and claimant information from uploaded documents, verifies the policy is active, classifies the claim by type and complexity, and routes it to the appropriate handler — all within minutes.

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What you need

Data sources

  • Claims management system — Claim records, handler assignments, and status tracking
  • Policy administration system — Active policies with coverage terms, effective dates, and endorsements

Knowledge spaces

  • Claim documents — FNOL (First Notice of Loss) forms, police reports, medical bills, and repair estimates uploaded by claimants
  • Underwriting guidelines — Classification rules and routing criteria by claim type and complexity
Semantic layer: Define these in your ontology before setting up the agent.
See building a semantic layer for a step-by-step guide.

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Agent setup

1

Create the agent

Go to Agent Space > New agent.
2

Set the description

You process incoming insurance claims. Extract key information from submissions: policy number, date of loss, claim type, claimant details, and supporting documents. Classify each claim by type (auto, property, liability, health) and complexity (simple, moderate, complex). Use a formal, precise tone — this is regulated work. Flag any missing documentation immediately and specify exactly what is needed. Never make coverage determinations; your job is to intake and route.
3

Scope data access

Grant access to:
  • Claims management system data source (claim records)
  • Policy administration system data source (active policies)
  • Claim documents knowledge space
  • Underwriting guidelines knowledge space
  • Claim and Policy objects in the semantic layer
4

Add skills

Trigger: New claim documents uploaded or user asks to process a submission
  1. Read the uploaded documents from the knowledge space (FNOL forms, police reports, medical bills, repair estimates).
  2. Extract key fields: policy number, claimant name, date of loss, loss description, claimed amount, and involved parties.
  3. Cross-reference the policy number against the policy administration system to confirm the policy is active and the loss date falls within the coverage period.
  4. Classify the claim by type (auto, property, liability, health) based on the loss description.
  5. Assess complexity: simple (single event, clear liability), moderate (multiple parties), or complex (disputed liability, potential litigation).
  6. List any missing required documents for the claim type.
  7. Output a structured claim summary with all extracted fields, classification, and missing document list.
Trigger: Claim has been classified and is ready for assignment
  1. Read the claim type, complexity, and claimed amount from the intake summary.
  2. Look up the routing rules from the underwriting guidelines knowledge space.
  3. Match the claim to the appropriate handler queue based on type and complexity.
  4. For claims exceeding the high-value threshold, route to a senior adjuster.
  5. Assign the claim and update the status in the claims management system.

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Automation

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Playbook: New claim intake pipeline

1

Set the trigger

Set the playbook to trigger on a new claim submission event from the claims management system or document upload portal.
2

Build the workflow

The playbook processes the submission end-to-end: extract, validate, classify, and route.
  1. Query step — Pull the submitted documents and any form data from the claim submission.
  2. AI step — Extract policy number, claimant details, date of loss, loss description, and claimed amount from the documents.
  3. Query step — Look up the policy in the policy administration system to verify it is active and the loss date is covered.
  4. Condition step — If the policy is inactive or the loss date is outside coverage, flag the claim for manual review and stop processing.
  5. AI step — Classify the claim by type and complexity using the underwriting guidelines.
  6. Action step — Create the claim record in the claims management system with all extracted fields, classification, and assigned handler.
3

Configure delivery

Send a notification to the assigned handler via email with the claim summary and document links. If any required documents are missing, also send a request to the claimant’s email listing exactly what is needed.
4

Test and activate

Click Run now to test with live data, then toggle to Active.

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What’s next

Reserve estimation

Calculate initial reserves based on comparable historical claims.

All insurance use cases

See the full list.