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Claims Processor

Claims Policy Verification

This agentic task analyses insurance claim documentation against policy terms - useful for claims processing agents. The task configuration outlines how to:

  • Extract and validate claim particulars against policy terms and conditions

  • Analyse coverage limitations and exclusion clauses

  • Detect patterns indicating policy violations

  • Compare claim-to-policy alignment through structured assessment

  • Generate evidence-based handling recommendations with policy rationale


As a modular agentic task, it can be integrated into motor, home, health, and commercial insurance workflows, enabling AI agents to execute structured claim verification within existing systems. The task specification includes frameworks for policy interpretation, documentation analysis, and compliance verification protocols.

Example outputs:

"response": {
    "claim_summary": "Claim ID: CLM003 for $10,000 due to flooding caused by heavy rains, resulting in water damage to the basement and lower floors, including ruined carpeting, electrical damage, and structural repairs.",
    "discrepancies": [
      "The claim mentions a pre-existing crack in the basement wall, which may fall under the exclusion of pre-existing structural damage."
    ],
    "policy coverage": "The policy covers natural disasters, including flooding, up to $15,000 for structural and electrical damage, with a $1,000 deductible.",
    "verification_notes": "The claim is generally covered under the policy terms for natural disasters. However, the mention of a pre-existing crack could potentially affect coverage due to the exclusion of pre-existing structural damage.",
    "verification_result": "Partial Coverage",
    "recommended_actions": [
      "Request a home inspection report from the time of policy inception to verify the status of the basement wall crack.",
      "Clarify with the claimant whether the crack was documented as a pre-existing condition."