Certificate NS-C04 · Under NDA
Claims-negotiation agents
Agents that read an insurer’s estimate, find the line items it leaves out, write the argument for them, and keep negotiating by email until someone answers.
What it is
An insurance-claims negotiation system. It starts from the insurer’s estimate, a PDF, and works out what is missing from it: omitted items, and differences in quantity and scope.
It then writes the case for each one and runs the negotiation by email: it sends the argument, replies safely to the answers, and follows up on its own.
Process: what we built
Docling extracts the estimate. A scope ontology flags omitted items and quantity and scope variances. Gemini 2.5 Flash reasons over them, with safety post-processing on what it writes. The system writes a PDF variance report, and a stateful email worker sends the argument, replies and follows up.
Underneath: an IMAP state machine with recoverable jobs, mailboxes encrypted with AES-256-GCM, and multi-tenancy.
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Ingest
- PDF extraction (Docling)
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Understand
- Scope ontology
- Variance detection: omitted items, quantity, scope
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Reason
- Gemini 2.5 Flash
- Safety post-processing
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Act
- PDF variance report
- Email worker: sends, replies, follows up
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Run
- IMAP state machine
- Recoverable jobs
- Encrypted mailboxes
- Multi-tenant
Need something built to this standard?
Tell us what the system should decide or do. We’ll tell you plainly if AI isn’t the right tool.