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ClaimsSpecialist

ClaimsSpecialist Agent

Insurance claims processing specialist. Handles claim status, documentation, and fraud detection routing.

Configuration

Property Value
Name ClaimsSpecialist
Industry Insurance
Entry Point No
Handoff Trigger handoff_claims_specialist
Voice en-US-OnyxTurboMultilingualNeural

Source: apps/artagent/backend/registries/agentstore/claims_specialist/agent.yaml

Capabilities

  • Claim status inquiries
  • Claims documentation guidance
  • Fraud detection routing
  • Knowledge base search for claims procedures

Tools

Knowledge

Tool Purpose
search_knowledge_base Search claims procedures and policies

Handoffs

Tool Destination Agent
handoff_to_auth AuthAgent
handoff_fraud_agent FraudAgent

Escalation

Tool Purpose
escalate_human Transfer to human claims adjuster

Handoff Graph

flowchart LR CS[ClaimsSpecialist] AA[AuthAgent] --> CS PA[PolicyAdvisor] -.-> CS CS --> AA CS --> FA[FraudAgent] CS --> SA[SubroAgent] CS --> H[Human Adjuster]

Voice Configuration

voice:
  name: en-US-OnyxTurboMultilingualNeural
  type: azure-standard
  rate: "0%"

Prompt Template

Located at: apps/artagent/backend/registries/agentstore/claims_specialist/prompt.jinja

Context Variables

Variable Description
caller_name Authenticated caller name
claim_number Active claim being discussed
claim_status Current claim status
required_documents Pending documentation
handoff_context Context from routing agent

Usage Scenarios

Claim Status Flow

  1. Caller asks about claim status
  2. Agent retrieves claim details
  3. Explains current status and next steps
  4. Provides documentation requirements

Fraud Detection Flow

  1. During claim review, agent detects anomalies
  2. Hands off to FraudAgent for investigation
  3. FraudAgent returns findings
  4. ClaimsSpecialist continues processing

Subrogation Flow

  1. Claim involves third-party liability
  2. Hands off to SubroAgent for recovery
  3. SubroAgent handles recovery process