Dear Reader,

This article serves as Part #1 of the Build Log series on AuditFlow, a tool meant for agentic and explainable claims processing. This tool is meant to solve some of the leading problems in claims processing - routing and policy matching. The ideation phase identified these main purposes for this project: intent classification (identifying business line, geography etc.), contextual understanding for policy matching and explainable decision making.

1. Executive Summary

   Problem: Insurance claims triage is traditionally a “black box“ where simple automation fails to account for regional policy nuances. Manual overview of 100+ page policy PDFs causes massive delays whereas completely relying on agents becomes cost heavy.

   Solution: AuditFlow - an Agentic AI sysyem that uses a multi-microservice architecture to classify incoming claims, retrieve the exact regional policy wording, and provide a step-by-step audit report explaining why a claim was approved, flagged, or rejected.

2. User Stories & Use Cases