Begin with the workflow vocabulary
Claim intake, Policy servicing, Claims evidence review each have distinct inputs and review points. A shared vocabulary should explain what the core entities—Policy, Claim, Coverage period, Supporting document—mean and how they relate. A model cannot repair conflicting business definitions just by receiving a longer prompt.
Preserve context that changes the answer
Keep claim-to-policy relationships, document version, event date, and extraction confidence. Route missing evidence rather than inferring it. Record the source authority and the conditions under which information applies. An answer can be fluent and still be wrong because it used the wrong entity relationship, document version, unit, or time period.
Make evidence a product feature
A claims team repeatedly checks incoming submissions against a document checklist while finding the policy wording applicable to the reported event. The user experience should expose the evidence behind a proposed output and make uncertainty visible. Provide source links, relevant dates, and a clear distinction between observed records and model-produced interpretation.
Give agents a bounded responsibility
Extract submitted fields, flag missing documents, and prepare a review packet. Define this responsibility with explicit completion criteria and a small tool set. Keep retrieval, draft preparation, and record-changing actions separate in the permission model. An agent’s ability to suggest a next step does not imply authority to execute it.
Test the difficult cases first
Include conflicting identifiers, missing evidence, obsolete documents, and restricted records in evaluation. Proposed measures include field extraction correctness, checklist completeness, policy-reference accuracy, and exception routing quality. Also test whether reviewers can understand and correct an output without reconstructing the whole task themselves.
Keep the ownership model visible
Coverage, underwriting, and settlement decisions remain with authorized insurance personnel. Data stewards resolve source meaning and quality, platform teams operate access and reliability, and workflow owners accept the business behavior. Treat these responsibilities as part of the architecture rather than a handover note.
Architecture takeaway
Keep claim-to-policy relationships, document version, event date, and extraction confidence. Route missing evidence rather than inferring it. A useful AI experience preserves this context through ingestion, retrieval, generation, and review.