Claims Copilot
Insurance claims acceleration with policy validation, document analysis, and fraud signal detection.
Why claims operations are bottlenecked
- ●Claims adjusters handle high document volume with inconsistent structure and quality.
- ●Policy validation is time-consuming and requires cross-referencing multiple artifacts.
- ●Fraud indicators can be subtle and missed without pattern-aware analysis.
- ●Decision justification must be traceable for regulators and internal governance.
What Claims Copilot provides
Claim Review Workspace
CLM-44201 · Rear-impact collision · Estimate: $68,400
Document Extraction
| Document | Pages | Extracted Data | Status |
|---|---|---|---|
| Police Report | 3 | Incident details, parties | |
| Repair Estimate | 2 | Parts, labor costs | |
| Photos (12) | — | Damage assessment | |
| Medical Invoice | 1 | Treatment summary | pending |
Claim Summary
Claim document analysis
Parse and summarize claims packets into structured review artifacts.
Claim Review Workspace
CLM-44201 · Rear-impact collision · Estimate: $68,400
Document Extraction
| Document | Pages | Extracted Data | Status |
|---|---|---|---|
| Police Report | 3 | Incident details, parties | |
| Repair Estimate | 2 | Parts, labor costs | |
| Photos (12) | — | Damage assessment | |
| Medical Invoice | 1 | Treatment summary | pending |
Claim Summary
Policy condition validation
Cross-check claim details against insurance contract clauses.
Policy Validation
Cross-checking against contract clauses
Clause Matching
| Clause | Result | Detail |
|---|---|---|
| §8.2 Collision Coverage | matched | Damage type qualifies under comprehensive |
| §4.1 Deductible Rule | matched | $500 standard deductible applies |
| §12.3 Rental Extension | conditional | Requires proof of non-drivability |
Policy
Fraud signal detection
Flag risk indicators from patterns and inconsistencies.
Fraud Signal Analysis
Composite risk score: 0.28 (low-medium)
Signal Indicators
| Signal | Value | Risk |
|---|---|---|
| Claim velocity | 1 in 24mo | normal |
| Location consistency | Matches policy | low |
| Invoice anomaly | Labor rate +18% | medium |
| Prior claims pattern | No pattern | low |
Risk Assessment
Details
Adjuster decision assistance
Provide grounded recommendations to accelerate claims resolution.
Adjuster Recommendation
AI-assisted decision support · Confidence: 94%
Recommended Actions
Approve repair payout up to $61,500
Coverage verified, within policy limits
Request medical invoice before final settlement
Pending document — required for closure
Schedule secondary review in 48 hours
Standard process for claims > $50k
Decision
94%
Recommendation confidence
Policy-bound agents
Capability enforcement ensures autonomous systems operate within explicit boundaries.
Governance Flow
Policy-bound agent execution ensures autonomous systems operate within boundaries.
Autonomous systems require explicit boundaries.
Where it sits in the stack
PlantoOS Architecture
The stack relationship between apps, agents, runtime, and systems.
Applications
Products and workflows
Agents
LLM-powered autonomous units
PlantoOS Runtime
Execution · orchestration · control
Capability Layer
Policy enforcement and tool access
Medhara Core
Memory · governance · lineage
Enterprise + Public Systems
Databases, APIs, infrastructure
A new compute layer for systems operated by agents.
Key workflows
How data flows through the system in typical usage patterns.
Workflow 1
Input
New claim intake
Core Process
Summarizes submitted evidence and context
Output
Structured claim packet for adjuster review
Workflow 2
Input
Coverage verification
Core Process
Matches claim conditions to policy clauses and rules
Output
Traceable coverage recommendation
Workflow 3
Input
Fraud risk screening
Core Process
Flags anomalies from claim history and indicators
Output
Escalation recommendations for investigation
Measured outcomes
↓ 20–35%
Claim evaluation cycle time
↑ 15–25%
Coverage decision consistency
↑ 10–20%
Early fraud signal detection
Indicative ranges from internal benchmarks and early deployments; results vary by workload, model, and infrastructure.
How it integrates
SDK-first integration — governed from the first line of code.
Connect policy systems
Integrate contracts, claims, and document feeds
Define adjudication rules
Encode insurer validation and escalation logic
Assist adjusters
Deliver claim summaries and policy-grounded recommendations