Claims handling
RPA + agentic AI

Portal claims, read, classified and escalated — 24/7.

A bot watches the portal without pause and an AI agent reads each claim, classifies it by type and urgency and routes or escalates it — periodic manual review disappears.

24/7 without pause
Manual review eliminated
Classification by AI
The journey of a claim

From the portal intake to the right response

Five steps. The AI understands and classifies; the person decides only what is critical.

1

Continuous monitoring

The bot checks the claims portal without pause, day and night.

2

Reading the claim

An AI agent reads the text of the claim and understands what it is about.

3

Classification

It categorizes it by type and urgency with learned judgment, not with rigid rules.

4

Routing

It routes it to the right area and, if critical, escalates it immediately to a person.

5

Recording and response

It leaves a record and triggers the corresponding acknowledgment or response.

Capabilities

Built to never lose a single claim

It is not a script: it combines 24/7 automation with an AI agent that understands and decides.

🤖

24/7 monitoring

On Automation Anywhere V11: continuous portal surveillance, with no shifts.

🧠

Classification with agentic AI

An AI agent interprets each claim and decides its type and priority.

🧭

Intelligent routing

Each case reaches the right area, with no manual steps.

🚨

Automatic escalation

What is critical is raised instantly to a person — human control where it matters.

Immediate response

The acknowledgment or response goes out as soon as the claim arrives.

📊

Traceability

Each claim, its classification and its routing are recorded.

Operations and infrastructure

Industrial, not improvised

AI with judgment, human control over what is critical and an auditable record of every decision.

Human control (HITL)What is critical always passes through a person before acting.
Learned judgmentThe AI classifies by meaning, not by fragile rules.
Two environmentsTesting and production, isolated.
Auditable recordEvery classification and escalation is traced.

Less manual watching. Zero claims left unattended.

The team's time for the cases that require judgment; monitoring and classification for the AI — with every claim read, routed and recorded.

Back to the journey

Let's talk about your process

Tell us about your process and we will show you how to automate it.

Contact

tamara.kuschniroff@rpaforce.com · +54 11 5050 0222

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