Design 3: Insurance claim agent

Overview

A claim-preparation assistant inside an authoritative claim workflow. It gathers and drafts information without independently adjudicating claims.

Why this matters

Claim intake involves varied descriptions and documents.

An everyday example

An intake clerk helps complete a form that an authorized process later handles.

A technical example

Extract fields into a draft and attach original evidence references.

How it works

1. Verify ownership
2. Gather evidence
3. Validate draft
4. Review
5. Idempotent submission
6. Receipt.

Architecture and flow

Intake agent → validation → approval → claim service → receipt.

The insurance assistant example

Help file a motor claim while preserving staff approval responsibilities.

When to use it

Assisted intake and document preparation.

When to avoid it

Do not use a model alone for eligibility, denial, or financial settlement.

Interview answer

“AI prepares the claim; deterministic rules and authorized people control consequential decisions and submission.”

Benefits, trade-offs, and production considerations

• Persist immutable draft versions and approvals.
• On timeout, reconcile by operation key.
• Protect health/financial data and evaluate field errors and unauthorized-action attempts.