Insurance Processing on IB-X™

One platform for every step of an insurance claim, policy and underwriting file

IntelliBuddies® IB-X™ puts 18 specialised AI agents under a single orchestrator. They read documents, check coverage, screen for fraud, route approvals and update customers, on top of the core systems you already run.

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75%

faster first notice of loss (FNOL) processing

90%

of eligible claims straight-through

95%

document extraction accuracy

24×7

voice and digital claim registration

Notice arrives

Claim reported by call, email, portal, app or WhatsApp. Claim type is identified and a claim number assigned.

Documents are read

Forms, bills, discharge summaries, FIRs and KYC are classified and their data extracted.

Coverage is verified

Policy validity, waiting periods, limits, exclusions, deductibles and prior claims are checked against your core system.

Fraud is screened

Duplicates, altered documents, identity and location mismatches are scored before any money moves.

Assessment

Medical bills are mapped to ICD codes with payable and non-payable amounts. Surveyors are booked for motor and property.

Approval is routed

Low-value claims clear automatically. Larger ones go to the right manager or committee with a summary attached.

Payment is triggered

Approved claims flow to finance and payment systems with a full audit trail.

Customer is kept informed

Status updates go out by email, SMS or WhatsApp, and the voice agent answers "where is my claim?"

Register every claim in minutes, from any channel

The intake agent replaces manual re-keying at the first step, which is where most claim delays start.

Multi-channel intake Accepts documents and notices by voice, email, web portal, mobile app and messaging.

Automatic claim classification Identifies claim type and line of business from the content, not from a dropdown.

Claim number and record creation Creates the claim in Guidewire, Duck Creek or your own core system without re-entry.

Adjuster assignment and reserves Routes to the right adjuster and proposes an initial reserve from the extracted data.

Missing-information requests Asks the claimant for outstanding documents automatically and tracks the reply.

Claims Intake agent · Workflow Engine · Email and portal automation

Turn any insurance document into structured data

Intelligent Document Processing reads the paperwork that would otherwise need a person to interpret it.

OCR and classification Sorts incoming files into types such as ACORD forms, loss runs, hospital bills, discharge summaries, FIRs and repair estimates.

Identity documents Extracts and validates KYC data from Aadhaar, PAN and similar documents.

Rule-based validation Checks extracted fields against your business rules and flags what does not add up.

Layouts that vary Handles variable, handwritten and scanned inputs, and learns fixed templates through IntelliTrainer.

Intelligent Document Processing · IntelliTrainer · AI extraction

Check coverage the same way, every time

Verification is rule-driven and runs against live policy data, so decisions are consistent and explainable.

Policy and coverage checks Validity, waiting period, sum insured, limits, exclusions and deductibles.

Claim history Prior claims and cumulative payouts pulled into the same view.

Surveyor coordination Picks the nearest surveyor, schedules the visit, extracts the survey report and drafts a recommendation.

Configurable business rules Insurer- or product-specific rules maintained by your team, not hard-coded.

Exception handling Cases that fail a rule go to a queue with the reason attached, not to a dead end.

Claims Verification agent · Business Rules Engine · Core insurance APIs

Score fraud risk before payout, and send the right cases to SIU

Fraud checks run on every claim and every underwriting submission, so your investigators see fewer, better-prepared cases.

Duplicate and fake claims Finds repeat submissions across policies, providers and time windows.

Document manipulation Flags altered, reused or inconsistent documents.

Identity and geo mismatches Compares claimant identity and incident or provider location against the record.

Suspicious provider patterns Spots billing patterns that repeat across claims from the same provider.

Risk score with reasons Every score comes with the signals behind it. Higher-risk files route to SIU with the evidence compiled.

Learns from outcomes Investigator decisions feed back so the model improves on your own portfolio.

Fraud Detection agent · ML pattern detection · AI anomaly engine

For hospitals and TPAs: claims and pre-auth without the portal grind

Built on live hospital deployments. IB-X assembles the request from the patient record and works the insurer portals for your team.

Guided claim registration A step-by-step wizard for patient, insurer, policy, treatment, insurer-specific fields and documents, with drafts saved automatically.

AI pre-submission review Gives a completeness score and flags missing documents, unusual bill amounts, duplicate claims and treatment-to-diagnosis mismatches before you submit.

Portal automation Bots log in to insurer portals, fill forms, handle one-time passwords and sync claim status back to your system.

Medical coding Reads hospital bills and discharge summaries, maps ICD codes and separates payable from non-payable amounts.

Live claims dashboard Pipeline view from draft to approved or rejected, with rejection patterns and items needing action.

Connector coverage Ready connectors for around 80 insurance providers.

RPA agents (Smart Buddy) · AI review · IDP · Workflow Engine

Issue policies and assess new business faster

Submission handling, risk assessment and issuance run as one connected workflow.

Submission extraction Pulls data from ACORD forms, medical records and loss runs into the underwriting file.

Risk assessment Evaluates applicant profile, medical history, prior claims and external databases, then recommends a risk category.

Premium and issuance Calculates premium, generates the policy document and emails it to the customer.

Underwriter workbench handoff Complex cases reach an underwriter with a summary, not a folder of PDFs.

Quotes and advisory The acquisition agent answers queries, recommends policies, produces quotes, collects KYC and books advisor time.

Underwriting agent · Policy Issuance agent · Customer Acquisition agent

Answer the phone at any hour

Conversational agents handle routine service so your team is free for the calls that need a person.

Voice claim registration 24×7 inbound calls with identity verification over the call.

Policy enquiries and renewals Answers coverage questions from your own knowledge base and guides the customer through renewal.

Claim status on demand Customers ask, the agent checks the live claim and replies.

Human handoff Sentiment detection passes distressed or complex callers to a person with the conversation attached.

Channels Voice, web chat and WhatsApp from one agent definition.

Conversational Agent · Voice AI · Knowledge grounding

Under ₹50,000

Auto-approve

Clean claims that pass coverage and fraud checks are approved and sent for payment without a human touch.

₹50,000 to ₹5 lakh

Manager review

Routed to a claims manager with the extracted data, checks performed and a recommendation. SLA timers and escalation apply.

Above ₹5 lakh

Senior committee

Escalated with a complete case pack: documents, verification results, fraud score and audit trail.

Thresholds shown are typical defaults. Yours are set in the rules engine and can differ by product, region or fraud score.

Control & Trust

AI that checks, people who decide

IB-X automates the checking and the chasing. Decisions that carry financial or regulatory weight stay with your team, and everything is recorded.

Override with a reason Staff can proceed past any AI flag. The reason is stored with the claim.
Complete audit trail Every status change, bot action, approval and override is logged and exportable.
One place to monitor Each claim run, workflow and bot job appears in the AI Command Center with logs, retries and SLA tracking.
Your data stays yours Deploy as SaaS or self-hosted, and use managed AI services or your own model keys.

Example: AI review before submission

87 completeness score · can proceed

Required documents present Passed

No duplicate claim in 30 days Passed

Discharge summary looks unsigned. Upload the signed copy. Review

ICU charges are 23% above average for this treatment and insurer. Low

APIs

Direct, real-time connection where a system offers a usable API.

RPA

Bots operate legacy screens and insurer portals that have no API, inside your network.

Files

Batch files, spreadsheets and email attachments picked up and processed on schedule.

Events

Triggers from email, folders, webhooks and system events start workflows the moment something arrives.

Guidewire
Duck Creek
CRM
ERP and finance
Payment systems
Insurer and TPA portals
External fraud databases
Email and WhatsApp
Calendar

Area	Result	Where it comes from
First notice of loss	75% faster	Automated intake, classification and data extraction replace manual keying.
Claims straight-through	Up to 90%	Eligible claims pass coverage, fraud and approval rules without manual handling.
Underwriting turnaround	50% shorter	Submissions are extracted, scored and summarised before an underwriter opens them.
Policy issuance	70–90% faster	KYC, risk scoring, premium and document delivery run as one workflow.
Hospital billing errors	85% fewer	Checks before submission cut claim rejections and resubmissions.
Pre-authorisation	Same day	Requests assembled from the patient record and submitted by bot, down from 2 to 3 days.

Results depend on document quality, system access and rule design. Figures reflect typical outcomes and are confirmed against your data in the pilot.

IntelliBuddies® IB-X™

See a claim move through IB-X

Start with one process, such as claims intake, fraud screening or pre-authorisation. We run it on your documents in a pilot, then extend to the next.

Book a demo Contact Sales