Claims desk: an AI workflow for first notice of loss triage
A first notice of loss arrives: a rear-end collision in a parking lot, a $2,800 estimate, photos but no police report, and the third claim on the same vehicle this year. Someone has to decide whether to pay, investigate or deny, and the file note has to explain why.
This workflow does the reading and drafting. It extracts the facts, looks up the policy, routes to one of three drafting agents and then stops. Nothing that moves money or denies a claim leaves the graph until an examiner approves it.
Free in Sim. No account or API key.
Sample input
FNOL: rear-end in a parking lot. Bumper + taillight. Insured estimate $2,800. Third claim this year on the same vehicle. Photos mentioned, no police report. Decide pay / investigate / deny.
How the workflow runs, step by step
1. Start
Claim in
The claim note starts the run. The policy snippet is attached alongside it.
Next: Extract
2. Agent
Extract
A cheap model pulls the structured facts out of the note and the attachment.
Next: Policy lookup
3. Tool
Policy lookup
Searches a claims playbook, standing in for your policy system.
Next: Disposition
4. Router
Disposition
Keyword rules choose the disposition. Prior claims, fraud signals or SIU go to investigation, which is also the safe default.
Next: Pay draft (pay), Investigate brief (investigate), Deny draft (deny)
5. Agent
Pay draft
Drafts a payment worksheet for a clear-liability claim.
Next: Examiner approve
6. Agent
Investigate brief
Drafts the examiner and SIU questions for a claim that needs a closer look.
Next: Examiner approve
7. Agent
Deny draft
Drafts denial language. It never sends on its own.
Next: Examiner approve
8. Human approval
Examiner approve
Every disposition waits here. An examiner approves or rejects before money moves or a denial goes out.
Next: File note
9. Result
File note
The approved file note, ready for the claim system or Slack.
Why build it as a graph
Claims work needs an audit trail more than it needs clever prompting. A graph makes the decision path visible: which facts were pulled, which branch was taken and who approved it, with the examiner gate built into the workflow rather than left to habit.
Things to try
- Run the sample in Sim. The third-claim history sends it down the investigate branch.
- Rewrite the claim note, for example as a clear-liability claim with no prior history, and see which branch the router picks.
- Compare the cost per step: extraction and routing are cheap next to the drafting agents.