Coforge_Insurance_Claims_Adjuster_Agent

Coforge Claims Adjuster Agent transforms how insurance teams handle property and casualty claims from intake to settlement. Powered by the Nebulon Agentic AI Framework, it enables adjusters to process claims faster, reduce manual review effort, and communicate empathetically with customers, all while ensuring compliance and accuracy.

Unlike traditional rule-based claim engines, the Claims Adjuster Agent brings contextual reasoning, policy intelligence, and communication automation together in one interface. It intelligently reviews claim data, assesses policy coverage, detects anomalies, and drafts professional or empathetic responses significantly reducing turnaround time.

Key Capabilities

• Intelligent Claim Validation: Analyses submitted claim information: Name, Policy ID, Loss Description, and Address to validate against policy records, ensuring claim eligibility before routing.
• Data Retrieval & Context Building: Automatically fetches customer details, policy terms, historical claims, and coverage clauses from internal databases and document repositories to prepare a complete context view for the adjuster.
• AI-Based Fraud & Anomaly Detection: Applies pattern recognition and cross-verification to detect inconsistencies, duplicate claims, or potential fraud indicators, ensuring that high-risk cases are flagged early.
• Automated Summary Generation: Produces concise claim summaries highlighting incident details, damage assessment, claim value, and resolution status—reducing administrative burden for adjusters and managers.
• Empathetic Communication Drafting: Generates pre-approved, context-sensitive email drafts—such as settlement notifications, escalation messages, or empathy-driven customer responses—aligned with tone and policy standards.
• Workflow Integration: Integrates seamlessly with CRM, Claims Management Systems (CMS), and Outlook/Teams environments for unified claim tracking and collaboration.
• Conversational Querying: Adjusters can interact directly through Copilot or Teams to ask questions like “What’s the coverage limit for this claim?” or “Show me all high-value claims pending over 15 days.”

Industry Applications - Claims Adjuster Agent enhances operational efficiency across insurance segments:

• Property & Casualty Insurance: Simplifies claim evaluation, fraud detection, and customer correspondence for large-volume claims.
• Health & Life Insurance: Streamlines document verification, policy matching, and hospital claim validation processes.
• Automobile Insurance: Accelerates first notice of loss (FNOL) handling, repair estimation, and approval workflows.
• Reinsurance & Commercial Lines: Consolidates data across brokers and underwriters for high-value claim assessment.

By combining intelligence, empathy, and automation, Coforge Claims Adjuster Agent helps insurers achieve 40–60% faster claim resolution, higher customer satisfaction, and improved regulatory compliance.