AI Agentic RTW Management System
Implements a production-grade 7-agent agentic system with advanced AI capabilities including hierarchical memory (working, episodic, semantic, procedural), inter-agent messaging, dynamic agent spawning, self-healing with circuit breakers, and predictive analytics with uncertainty quantification. Provides human-in-the-loop checkpoints for high-stakes decisions with full observability.
Problem Statement
The challenge addressed
Solution Architecture
AI orchestration approach
AI Agentic RTW System Overview - Multi-agent processing dashboard showing 7 specialized workers (Workflow Orchestrator, Document Intelligence, Medical Analysis, Compliance & Regulations, Risk Assessment) with real-time token usage tracking and cost estimation
Human-in-the-Loop Checkpoint - Security gate interface displaying AI model confidence analysis across 5 dimensions (Overall 87%, Document 96%, Compliance 94%, Risk 89%, Job Matching 91%) with uncertainty quantification and approval workflow
Executive Results View - Final RTW recommendation showing 'Approve Early Return-to-Work with Modified Duty' at 87% confidence, executive summary with comprehensive analysis across medical, compliance, risk, and job matching dimensions
Process Summary Timeline - AI workflow execution visualization showing 4 phases (Case Intake, Multi-Agent Parallel Analysis, Human-in-the-Loop Review, RTW Plan Generation) with performance metrics: 45.2s total processing, 7 agent executions, 8 tool calls
AI Agents
Specialized autonomous agents working in coordination
Orchestrator
RTW case processing requires coordinating 6 specialized agents through multi-phase workflows (intake, document processing, medical analysis, compliance, risk assessment, job matching, recommendation, approval) while managing state, handling failures, and ensuring human oversight at critical checkpoints.
Core Logic
Implements hierarchical task decomposition with phase-based workflow orchestration. Manages agent state machines, coordinates parallel and sequential execution, handles human-in-the-loop checkpoints with configurable approval options, implements circuit breaker patterns for fault tolerance, and provides real-time streaming of agent thoughts and actions through event sourcing.
Document Processor
RTW cases arrive with surgical reports, physical therapy notes, physician clearances, and accommodation requests in various formats that require accurate extraction of medical entities, key findings, and structured data for downstream analysis.
Core Logic
Processes medical documents through specialized extraction pipelines for medical records, physician notes, diagnostic reports, FMLA forms, and accommodation requests. Extracts entities (diagnoses, procedures, restrictions, physicians) with confidence scores, generates document summaries, identifies key findings, and tracks processing status through pending/processing/processed/error states.
Medical Analyzer
Determining appropriate return-to-work timing and restrictions requires analyzing ICD-10 diagnosis codes, surgical procedures, treatment protocols, and physician recommendations against medical guidelines and similar case outcomes.
Core Logic
Executes medical record search and ICD-10 code extraction using specialized retrieval tools. Analyzes diagnosis severity, treatment progress, and recovery trajectory. Generates medical necessity determinations with confidence scores and supporting citations. Maintains working memory of analysis context and episodic memory of similar case outcomes.
Compliance Checker
RTW decisions must comply with FMLA job restoration requirements, ADA reasonable accommodation mandates, and state-specific rules that vary by jurisdiction and interact in complex ways.
Core Logic
Verifies FMLA eligibility with weeks available/used/remaining tracking and expiration dates. Assesses ADA accommodation requirements with compliance status tracking. Identifies state-specific rules by employee location with applicability analysis. Generates compliance recommendations with required actions and regulatory citations.
Risk Assessor
RTW cases carry risks of premature return (re-injury), delayed return (increased costs), improper accommodation (ADA violations), and claim complexity that require systematic evaluation for appropriate intervention planning.
Core Logic
Calculates overall risk scores (0-100) with tier classification (low/moderate/high/critical). Identifies individual risk factors with positive/negative impact indicators, weights, and explanations. Generates recommended interventions with timing, estimated cost, expected impact, and priority rankings. Supports predictive analytics with model performance metrics and feature importance.
Job Matcher
When employees cannot return to their original position due to restrictions, identifying suitable alternative positions requires matching physical capabilities, schedule constraints, and skill requirements against available openings.
Core Logic
Searches job positions using availability and restriction criteria. Calculates compatibility scores across physical match, schedule match, and overall fit. Identifies specific restrictions affecting each position and benefits of placement. Ranks top matches by compatibility score with detailed analysis notes explaining placement rationale.
Recommendation Engine
Final RTW recommendations must synthesize medical analysis, compliance requirements, risk factors, and job matching results into actionable decisions with clear rationale, confidence levels, and supporting evidence for human review.
Core Logic
Aggregates outputs from all specialized agents using weighted synthesis. Generates final recommendations (approved/denied/pending review/pending info) with confidence scores and multi-step reasoning chains. Provides citations from analyzed documents, calculates financial impact (estimated claim cost, potential savings, intervention ROI), and prepares HITL checkpoint packages with summary, supporting evidence, and decision options.
Worker Overview
Technical specifications, architecture, and interface preview
System Overview
Technical documentation
Tech Stack
6 technologies
Architecture Diagram
System flow visualization