AI Claims Processing Agent
Let AI handle the manual operational work
Let AI handle the manual operational work
V7 Go's claims processing agent validates claims, verifies coverage, and calculates payments automatically. Convert messy, unformatted claims documents into structured, actionable data with every insight linked to its source.
Why V7 Go
Why V7 Go
Claim Validation
Automatically review claims submissions for completeness and accuracy. Identify missing information, inconsistencies, and potential fraud indicators while prioritizing claims based on complexity and urgency.
Claim Validation
Automatically review claims submissions for completeness and accuracy. Identify missing information, inconsistencies, and potential fraud indicators while prioritizing claims based on complexity and urgency.
Claim Validation
Automatically review claims submissions for completeness and accuracy. Identify missing information, inconsistencies, and potential fraud indicators while prioritizing claims based on complexity and urgency.
Coverage Verification
Analyze policy documents to determine coverage applicability for specific claims. Identify relevant policy provisions, exclusions, and limitations that impact claim decisions.
Coverage Verification
Analyze policy documents to determine coverage applicability for specific claims. Identify relevant policy provisions, exclusions, and limitations that impact claim decisions.
Coverage Verification
Analyze policy documents to determine coverage applicability for specific claims. Identify relevant policy provisions, exclusions, and limitations that impact claim decisions.
Payment Calculation
Determine appropriate payment amounts based on policy terms, coverage limits, deductibles, and claim documentation. Apply complex calculation rules consistently across similar claims.
Payment Calculation
Determine appropriate payment amounts based on policy terms, coverage limits, deductibles, and claim documentation. Apply complex calculation rules consistently across similar claims.
Payment Calculation
Determine appropriate payment amounts based on policy terms, coverage limits, deductibles, and claim documentation. Apply complex calculation rules consistently across similar claims.
Claims Document Processing
Extract key information from diverse claim documents including First Notice of Loss forms, medical reports, repair estimates, and supporting evidence. Process documents in any format—from PDFs and images to handwritten notes.
Claims Document Processing
Extract key information from diverse claim documents including First Notice of Loss forms, medical reports, repair estimates, and supporting evidence. Process documents in any format—from PDFs and images to handwritten notes.
Claims Document Processing
Extract key information from diverse claim documents including First Notice of Loss forms, medical reports, repair estimates, and supporting evidence. Process documents in any format—from PDFs and images to handwritten notes.
Coverage Evaluation
Assess whether claimed losses are covered under the specific policy provisions. Identify applicable coverage sections, evaluate policy conditions, and determine if exclusions apply to specific claim elements.
Coverage Evaluation
Assess whether claimed losses are covered under the specific policy provisions. Identify applicable coverage sections, evaluate policy conditions, and determine if exclusions apply to specific claim elements.
Coverage Evaluation
Assess whether claimed losses are covered under the specific policy provisions. Identify applicable coverage sections, evaluate policy conditions, and determine if exclusions apply to specific claim elements.
Payment Assessment
Calculate appropriate settlement amounts based on documented losses, policy limits, and applicable deductibles. Apply consistent valuation methodologies across similar claim types for fair and equitable settlements.
Payment Assessment
Calculate appropriate settlement amounts based on documented losses, policy limits, and applicable deductibles. Apply consistent valuation methodologies across similar claim types for fair and equitable settlements.
Payment Assessment
Calculate appropriate settlement amounts based on documented losses, policy limits, and applicable deductibles. Apply consistent valuation methodologies across similar claim types for fair and equitable settlements.
Why V7 Go
Documents processed by the AI Claims Processing Agent
Key data extracted during claims processing
Workflow
Workflow
Import your files
Guidewire ClaimCenter
,
Duck Creek Claims
,
Salesforce
First Notice of Loss Forms
First Notice of Loss Forms
First Notice of Loss Forms
First Notice of Loss Forms
Medical Reports
Medical Reports
Medical Reports
Medical Reports
Repair Estimates
Repair Estimates
Repair Estimates
Repair Estimates
Policy Documents
Policy Documents
Policy Documents
Policy Documents
Incident Reports
Incident Reports
Incident Reports
Incident Reports
Supporting Evidence
Supporting Evidence
Supporting Evidence
Supporting Evidence
Claimant information and contact details
Claimant information and contact details
Claimant information and contact details
Claimant information and contact details
Loss date, location, and description
Loss date, location, and description
Loss date, location, and description
Loss date, location, and description
Policy coverage details and limits
Policy coverage details and limits
Policy coverage details and limits
Policy coverage details and limits
Damage assessment and valuation
Damage assessment and valuation
Damage assessment and valuation
Damage assessment and valuation
Deductible amounts and application
Deductible amounts and application
Deductible amounts and application
Deductible amounts and application
Coverage exclusions and limitations
Coverage exclusions and limitations
Coverage exclusions and limitations
Coverage exclusions and limitations
Prior claims history and patterns
Prior claims history and patterns
Prior claims history and patterns
Prior claims history and patterns
Payment calculation components
Payment calculation components
Payment calculation components
Payment calculation components
Third-party information and liability
Third-party information and liability
Third-party information and liability
Third-party information and liability
Recovery and subrogation opportunities
Recovery and subrogation opportunities
Recovery and subrogation opportunities
Recovery and subrogation opportunities
Time comparison
Time comparison
Time comparison
Time comparison
Traditional way
2-3 hours per claim
2-3 hours per claim
With V7 Go agents
10-20 minutes per claim
10-20 minutes per claim
Average time saved
60-80%
60-80%
V7 Go
V7 Go
V7 Go
V7 Go
AI-powered solutions
AI-powered solutions
for insurance professionals
Insurance claims handlers spend hours manually reviewing claims documents, verifying coverage, and calculating payments—repetitive work that delays claims resolution and reduces customer satisfaction. This labor-intensive process creates bottlenecks, particularly when dealing with complex claims involving multiple documents and policy provisions. V7 Go's claims processing agent automates claim validation, coverage verification, and payment calculation, reducing processing time by 60% while ensuring accuracy.
Claims Adjusters
Focus on complex decision-making and customer interaction while the agent handles document review and routine calculations. Process more claims with greater consistency and less administrative burden.
Claims Adjusters
Focus on complex decision-making and customer interaction while the agent handles document review and routine calculations. Process more claims with greater consistency and less administrative burden.
Claims Adjusters
Focus on complex decision-making and customer interaction while the agent handles document review and routine calculations. Process more claims with greater consistency and less administrative burden.
Claims Adjusters
Focus on complex decision-making and customer interaction while the agent handles document review and routine calculations. Process more claims with greater consistency and less administrative burden.
Claims Managers
Gain visibility into claims operations with standardized processing and detailed analytics. Improve team productivity while ensuring consistent application of claims guidelines.
Claims Managers
Gain visibility into claims operations with standardized processing and detailed analytics. Improve team productivity while ensuring consistent application of claims guidelines.
Claims Managers
Gain visibility into claims operations with standardized processing and detailed analytics. Improve team productivity while ensuring consistent application of claims guidelines.
Claims Managers
Gain visibility into claims operations with standardized processing and detailed analytics. Improve team productivity while ensuring consistent application of claims guidelines.
FAQ
FAQ
FAQ
FAQ
Have questions?
Find answers.
How does the claims processing agent handle First Notice of Loss (FNOL) information?
The agent extracts and organizes key information from FNOL submissions regardless of format—whether structured forms, emails, scanned documents, or even audio recordings of reported claims. It identifies critical details including loss date, type, location, and claimant information. The system flags missing or inconsistent information for immediate follow-up while routing claims to appropriate handlers based on complexity, severity, and coverage type. Each extracted data point links directly to its source in the original submission for easy verification.
+
How does the claims processing agent handle First Notice of Loss (FNOL) information?
The agent extracts and organizes key information from FNOL submissions regardless of format—whether structured forms, emails, scanned documents, or even audio recordings of reported claims. It identifies critical details including loss date, type, location, and claimant information. The system flags missing or inconsistent information for immediate follow-up while routing claims to appropriate handlers based on complexity, severity, and coverage type. Each extracted data point links directly to its source in the original submission for easy verification.
+
How does the claims processing agent handle First Notice of Loss (FNOL) information?
The agent extracts and organizes key information from FNOL submissions regardless of format—whether structured forms, emails, scanned documents, or even audio recordings of reported claims. It identifies critical details including loss date, type, location, and claimant information. The system flags missing or inconsistent information for immediate follow-up while routing claims to appropriate handlers based on complexity, severity, and coverage type. Each extracted data point links directly to its source in the original submission for easy verification.
+
How does the claims processing agent handle First Notice of Loss (FNOL) information?
The agent extracts and organizes key information from FNOL submissions regardless of format—whether structured forms, emails, scanned documents, or even audio recordings of reported claims. It identifies critical details including loss date, type, location, and claimant information. The system flags missing or inconsistent information for immediate follow-up while routing claims to appropriate handlers based on complexity, severity, and coverage type. Each extracted data point links directly to its source in the original submission for easy verification.
+
Can the agent process complex claims with multiple documents and evidence types?
Yes, the agent excels at handling complex claims involving diverse document types. It processes medical reports, repair estimates, photographs, witness statements, expert opinions, and other supporting evidence in a coordinated manner. The system maintains relationships between different documents related to the same claim, creating a comprehensive view of the entire claim file. For complex claims, the agent identifies interdependencies between documents and highlights potentially conflicting information that requires further investigation.
+
Can the agent process complex claims with multiple documents and evidence types?
Yes, the agent excels at handling complex claims involving diverse document types. It processes medical reports, repair estimates, photographs, witness statements, expert opinions, and other supporting evidence in a coordinated manner. The system maintains relationships between different documents related to the same claim, creating a comprehensive view of the entire claim file. For complex claims, the agent identifies interdependencies between documents and highlights potentially conflicting information that requires further investigation.
+
Can the agent process complex claims with multiple documents and evidence types?
Yes, the agent excels at handling complex claims involving diverse document types. It processes medical reports, repair estimates, photographs, witness statements, expert opinions, and other supporting evidence in a coordinated manner. The system maintains relationships between different documents related to the same claim, creating a comprehensive view of the entire claim file. For complex claims, the agent identifies interdependencies between documents and highlights potentially conflicting information that requires further investigation.
+
Can the agent process complex claims with multiple documents and evidence types?
Yes, the agent excels at handling complex claims involving diverse document types. It processes medical reports, repair estimates, photographs, witness statements, expert opinions, and other supporting evidence in a coordinated manner. The system maintains relationships between different documents related to the same claim, creating a comprehensive view of the entire claim file. For complex claims, the agent identifies interdependencies between documents and highlights potentially conflicting information that requires further investigation.
+
How does the agent verify coverage for specific claims?
The agent analyzes the applicable policy documents, including all endorsements and amendments, to determine coverage for specific claims. It identifies relevant policy sections, conditions, exclusions, and limitations that apply to the particular loss scenario. The system recognizes coverage nuances such as sublimits, special conditions, and claims-made vs. occurrence-based triggers. Each coverage determination includes links to the specific policy language being applied, ensuring transparency and verifiability in coverage decisions.
+
How does the agent verify coverage for specific claims?
The agent analyzes the applicable policy documents, including all endorsements and amendments, to determine coverage for specific claims. It identifies relevant policy sections, conditions, exclusions, and limitations that apply to the particular loss scenario. The system recognizes coverage nuances such as sublimits, special conditions, and claims-made vs. occurrence-based triggers. Each coverage determination includes links to the specific policy language being applied, ensuring transparency and verifiability in coverage decisions.
+
How does the agent verify coverage for specific claims?
The agent analyzes the applicable policy documents, including all endorsements and amendments, to determine coverage for specific claims. It identifies relevant policy sections, conditions, exclusions, and limitations that apply to the particular loss scenario. The system recognizes coverage nuances such as sublimits, special conditions, and claims-made vs. occurrence-based triggers. Each coverage determination includes links to the specific policy language being applied, ensuring transparency and verifiability in coverage decisions.
+
How does the agent verify coverage for specific claims?
The agent analyzes the applicable policy documents, including all endorsements and amendments, to determine coverage for specific claims. It identifies relevant policy sections, conditions, exclusions, and limitations that apply to the particular loss scenario. The system recognizes coverage nuances such as sublimits, special conditions, and claims-made vs. occurrence-based triggers. Each coverage determination includes links to the specific policy language being applied, ensuring transparency and verifiability in coverage decisions.
+
How accurate are the payment calculations performed by the agent?
The agent's payment calculations maintain 96-98% accuracy compared to experienced claims adjusters, with full transparency into how each figure is derived. The system applies consistent calculation methodologies based on documented losses, policy provisions, applicable deductibles, and benefit limits. For complex calculations involving depreciation, coinsurance, or specialized valuation rules, the agent shows its work step-by-step. Human adjusters can review these calculations, understand the logic applied, and make adjustments if necessary based on their expertise.
+
How accurate are the payment calculations performed by the agent?
The agent's payment calculations maintain 96-98% accuracy compared to experienced claims adjusters, with full transparency into how each figure is derived. The system applies consistent calculation methodologies based on documented losses, policy provisions, applicable deductibles, and benefit limits. For complex calculations involving depreciation, coinsurance, or specialized valuation rules, the agent shows its work step-by-step. Human adjusters can review these calculations, understand the logic applied, and make adjustments if necessary based on their expertise.
+
How accurate are the payment calculations performed by the agent?
The agent's payment calculations maintain 96-98% accuracy compared to experienced claims adjusters, with full transparency into how each figure is derived. The system applies consistent calculation methodologies based on documented losses, policy provisions, applicable deductibles, and benefit limits. For complex calculations involving depreciation, coinsurance, or specialized valuation rules, the agent shows its work step-by-step. Human adjusters can review these calculations, understand the logic applied, and make adjustments if necessary based on their expertise.
+
How accurate are the payment calculations performed by the agent?
The agent's payment calculations maintain 96-98% accuracy compared to experienced claims adjusters, with full transparency into how each figure is derived. The system applies consistent calculation methodologies based on documented losses, policy provisions, applicable deductibles, and benefit limits. For complex calculations involving depreciation, coinsurance, or specialized valuation rules, the agent shows its work step-by-step. Human adjusters can review these calculations, understand the logic applied, and make adjustments if necessary based on their expertise.
+
Can the claims processing agent integrate with our existing claims management system?
Yes, the agent integrates with major claims management platforms including Guidewire ClaimCenter, Duck Creek Claims, Salesforce, and custom-built systems. It can pull claim information directly from your existing system and push processed results back into your workflows. The API supports bidirectional data exchange, allowing the agent to function as an intelligent layer within your current claims ecosystem. This integration capability means you can enhance your existing processes without disrupting established workflows or requiring staff to learn entirely new systems.
+
Can the claims processing agent integrate with our existing claims management system?
Yes, the agent integrates with major claims management platforms including Guidewire ClaimCenter, Duck Creek Claims, Salesforce, and custom-built systems. It can pull claim information directly from your existing system and push processed results back into your workflows. The API supports bidirectional data exchange, allowing the agent to function as an intelligent layer within your current claims ecosystem. This integration capability means you can enhance your existing processes without disrupting established workflows or requiring staff to learn entirely new systems.
+
Can the claims processing agent integrate with our existing claims management system?
Yes, the agent integrates with major claims management platforms including Guidewire ClaimCenter, Duck Creek Claims, Salesforce, and custom-built systems. It can pull claim information directly from your existing system and push processed results back into your workflows. The API supports bidirectional data exchange, allowing the agent to function as an intelligent layer within your current claims ecosystem. This integration capability means you can enhance your existing processes without disrupting established workflows or requiring staff to learn entirely new systems.
+
Can the claims processing agent integrate with our existing claims management system?
Yes, the agent integrates with major claims management platforms including Guidewire ClaimCenter, Duck Creek Claims, Salesforce, and custom-built systems. It can pull claim information directly from your existing system and push processed results back into your workflows. The API supports bidirectional data exchange, allowing the agent to function as an intelligent layer within your current claims ecosystem. This integration capability means you can enhance your existing processes without disrupting established workflows or requiring staff to learn entirely new systems.
+
How does the agent handle human-in-the-loop verification?
The agent supports configurable human-in-the-loop guardrails at any stage of the claims process. You can set thresholds for claim complexity, value, or specific attributes that trigger human review. The system presents relevant information and its analysis in a clear, structured format that enables efficient human verification. Adjusters can approve, modify, or override the agent's recommendations with a clear audit trail of decisions. This approach combines AI efficiency with human expertise, particularly valuable for complex or high-value claims that benefit from experienced judgment.
+
How does the agent handle human-in-the-loop verification?
The agent supports configurable human-in-the-loop guardrails at any stage of the claims process. You can set thresholds for claim complexity, value, or specific attributes that trigger human review. The system presents relevant information and its analysis in a clear, structured format that enables efficient human verification. Adjusters can approve, modify, or override the agent's recommendations with a clear audit trail of decisions. This approach combines AI efficiency with human expertise, particularly valuable for complex or high-value claims that benefit from experienced judgment.
+
How does the agent handle human-in-the-loop verification?
The agent supports configurable human-in-the-loop guardrails at any stage of the claims process. You can set thresholds for claim complexity, value, or specific attributes that trigger human review. The system presents relevant information and its analysis in a clear, structured format that enables efficient human verification. Adjusters can approve, modify, or override the agent's recommendations with a clear audit trail of decisions. This approach combines AI efficiency with human expertise, particularly valuable for complex or high-value claims that benefit from experienced judgment.
+
How does the agent handle human-in-the-loop verification?
The agent supports configurable human-in-the-loop guardrails at any stage of the claims process. You can set thresholds for claim complexity, value, or specific attributes that trigger human review. The system presents relevant information and its analysis in a clear, structured format that enables efficient human verification. Adjusters can approve, modify, or override the agent's recommendations with a clear audit trail of decisions. This approach combines AI efficiency with human expertise, particularly valuable for complex or high-value claims that benefit from experienced judgment.
+
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Next steps
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Next steps
Have a use case in mind?
Let's talk
You’ll hear back in less than 24 hours
Next steps
Have a use case in mind?
Let's talk
You’ll hear back in less than 24 hours
Next steps
Have a use case in mind?
Let's talk