AgenticX ClaimForge

Meta-agent that coordinates the 12 claims specialists across the 9-phase lifecycle (intake -> coverage review -> evidence gathering -> valuation -> negotiation -> settlement -> compliance review -> closed). Routes work, surfaces blockers, and assesses transition readiness.

“Where is each open claim in the lifecycle right now?”

First notice of loss (FNOL) intake and triage. Captures loss details, claimant identity, policy lookup, channel of first report, and produces the structured intake report ready for coverage review.

“Process this FNOL and produce the structured intake report.”

Policy-coverage analysis and verification. Reads the policy declarations, applicable endorsements, exclusions, deductibles, and limits to produce a coverage memo with reservation-of-rights (ROR) recommendations when warranted.

“Analyze coverage for this loss against the policy.”

Evidence collection and documentation. Drafts police-report requests, recorded-statement scheduling, repair estimates, photo / scene documentation requests, witness contact sequences, and supporting-document checklists.

“Build the evidence-collection plan for this claim.”

Damage valuation and reserve-setting. Produces component-level cost estimates, applies depreciation tables, calculates ACV / RCV positions, and recommends initial reserves with confidence bands.

“Value this loss with both ACV and RCV positions.”

Settlement-negotiation strategy and counter-offer specialist. Builds opening positions, prepares evidence-anchored responses to counters, applies state bad-faith timing constraints, and produces a recommended walk-away band.

“Build the opening settlement strategy for this claim.”

Settlement processing and disbursement. Issues release documents, schedules payment + deductible application, prepares the closure package, handles subrogation referrals, and confirms salvage / total-loss disposition.

“Build the settlement package for this accepted offer.”

Internal-controls assistant for the claims function: state prompt-payment-statute timing tracking, UCPA / NAIC fair-claims-practices reviews, DOI complaint posture, MSP / MMSEA reporting hooks, ERISA notice tracking, audit-trail completeness, policy-exception logging. Procedural-claims scope only; not a §9.3 jurisdiction agent.

“Run the prompt-payment-statute timing audit on the open book.”

Claimant and stakeholder communications. Drafts acknowledgment letters, status updates, request-for-information templates, ROR letters, denial letters with state-required language, and settlement-offer cover letters. Active across multiple phases as a cross-phase guardrail.

“Draft the acknowledgment letter for this new FNOL.”

Claims-fraud detection and SIU referral. Surfaces red flags (timing anomalies, prior-claim patterns, evidence inconsistencies, social-media indicators), runs NICB / ISO ClaimSearch hits when integrated, and produces SIU referral packets with documented severity bands.

“Screen this morning's intake batch for fraud signals.”

Catastrophe-event response and triage. Handles PCS event identification, FEMA / NFIP coordination references, IBNR estimation, surge-staff routing recommendations, and CAT-batch intake summarization.

“Classify this CAT event and recommend surge-staff routing.”

Claims reporting and analytics — claim-volume, cycle-time, leakage trend analysis, DOI-ready audit trails, NAIC market-conduct response packets, internal scorecards, and exec briefings. Audience-aware briefings for claims-VP / CFO / external auditor.

“Build the weekly claims-aging output.”

Per-claim case orchestration and cross-phase synthesis. Tracks open tasks, escalates SLA breaches, rolls up agent outputs into a single case status, and synthesizes a controller-ready timeline of decisions and evidence. Active across all non-initialized phases.

“Build the case status snapshot for this claim.”