Insurance Renewal Assessment Digital Worker

Core Logic

The Workflow Orchestrator coordinates the execution of all specialized agents through a structured four-phase workflow. It manages data flow between agents, routes tasks based on dependencies, resolves conflicting recommendations through weighted consensus, maintains comprehensive audit trails of all decisions, and ensures workflow completion within defined SLAs. The orchestrator uses GPT-4o with low temperature for deterministic coordination.

Core Logic

The Data Extraction Agent uses GPT-4o-mini to parse uploaded policy documents, extract structured data from certificates and census files, validate data completeness against required fields, cross-reference with policy database records, normalize date formats and currencies, and flag missing or inconsistent information. It employs Document Intelligence tools for OCR processing and produces data quality reports for downstream agents.

Core Logic

The Risk Analysis Agent leverages Claude 3.5 Sonnet for advanced reasoning to evaluate multi-dimensional risk factors. It executes proprietary risk scoring ML models, compares metrics against industry benchmarks, identifies risk concentration areas within portfolios, calculates weighted risk scores across age, claims, and operational dimensions, and generates risk mitigation strategies with confidence scores. The agent performs trend analysis to detect deteriorating risk profiles.

Core Logic

The Claims Intelligence Agent uses GPT-4o to analyze 12-month claims history, detecting seasonal patterns using time-series analysis. It identifies top cost drivers, calculates claim severity trends, forecasts future claims using statistical models, computes loss ratio trajectories, and prepares comprehensive claims intelligence reports. The agent uses semantic search to find relevant historical precedents for unusual claim patterns.

Core Logic

The Fraud Detection Agent employs Claude 3.5 Sonnet with ML-powered fraud pattern detection to scan claims for known fraud indicators, analyze provider billing patterns for anomalies, detect duplicate claim submissions, validate claim-diagnosis consistency against medical protocols, run anomaly detection models, and generate fraud risk scores with investigation recommendations. The agent screens entities against sanction lists for compliance.

Core Logic

The Pricing Optimization Agent uses GPT-4o to apply actuarial pricing models incorporating risk-adjusted factors from other agents. It models wellness program impacts on claims, fetches competitor pricing intelligence for market positioning, generates multiple pricing scenarios (conservative, balanced, aggressive), computes agent consensus scores across scenarios, and produces pricing recommendations with detailed rationale and competitive analysis.

Core Logic

The Compliance Check Agent uses Claude 3.5 Haiku for fast, accurate compliance validation. It initiates KYC verification against official registries, validates company registration status, screens entities against global sanction and PEP lists, checks IRDAI compliance requirements for policy terms, validates premium calculation methodology against regulations, and generates compliance certificates with full documentation for audits.

Core Logic

The Recommendation Synthesis Agent uses GPT-4o to aggregate findings from all agents, weight and prioritize recommendations based on impact and confidence, resolve conflicting assessments through evidence evaluation, generate clear actionable recommendations with executive summaries, prepare comprehensive audit trail documentation, and produce final renewal decisions (approve, approve-with-conditions, refer-to-underwriter, decline) with detailed rationale.