Claim Assistant
AI-powered claim intake automation that extracts, validates, and analyzes insurance claim forms using document intelligence and large language models.
Try Live DemoOverview
The Problem
Insurance claim processing is manual, error-prone, and slow. Adjusters spend hours extracting data from PDF forms, cross-referencing policy records, and writing coverage analyses, repetitive work that delays claim resolution.
Our Solution
Claim Assistant automates the entire intake pipeline: Azure Document Intelligence extracts key-value pairs from scanned PDFs, GPT-5 maps extractions to structured form fields with evidence tracking, and an LLM-powered validation engine performs coverage analysis against policy records.
Key Outcomes
- Automated field extraction with confidence scoring (flags fields below 80% for human review)
- Evidence-tracked form filling: every answer links back to source document extractions
- Policy matching with weighted name similarity (Levenshtein) and date validation
- LLM-generated coverage analysis with reasoning and confidence scores
Models & Tech Stack
AI/ML Models
Uses the prebuilt-document model to extract key-value pairs with confidence scores and bounding regions from insurance claim PDFs across 8+ US states.
GPT-5.2 performs form filling by mapping DI extractions to form fields using structured output parsing. GPT-5-nano handles coverage analysis, reasoning about whether claims fall within policy terms.
Tech Stack
Data & Methodology
Data Sources
State-specific insurance claim form templates (FL, NH, MN, IA, KS, NY, OH, WI) with structured field schemas, plus a policy database with coverage terms, holder information, and validity periods.
Methodology
5-stage modular pipeline: (1) Data Preparation - normalize scanned PDFs, (2) Key Extraction - Azure DI prebuilt-document model extracts key-value pairs with confidence scores, (3) Form Filling - GPT-5.2 maps extractions to form fields with one-to-many evidence tracking, (4) Policy Matching - lookup by policy ID with weighted Levenshtein name verification, (5) Validation - LLM-based coverage analysis with date and claimant verification.
Evaluation Metrics
Field extraction confidence threshold: 80%. Name matching uses weighted similarity: 60% policy ID, 15% first name, 25% last name.
Preview
Try It Yourself
Experience Claim Assistant with real data. No signup required.