Does the AI make the final payout decision?
Your criteria decide how much is automated. Low-confidence and exception cases go to reviewers as pending_review, with the reasoning already laid out.
ARGOS Omni · Insurance claim review
Automate insurance claimdocument review with AI.
ARGOS Omni, a Review Ops Agent, reviews insurance claim documents. It cross-checks the claim form, medical or accident records and policy information, confirms the required documents are present and the payout criteria are met, and sends cases with anomalies, omissions or exceptions to a reviewer.
Omni · Insurance claim review
- DOCClaim formDONE
- DOCMedical or accident recordsDONE
- DOCPolicy informationPROCESSING
- DOCCustomer informationQUEUED
Decision
verifiedrejectedpending_review
Review steps
Review steps,run in this order.
- Step 01
Confirm the claim information
- Step 02
Verify the required documents
- Step 03
Cross-check against the policy
- Step 04
Apply the payout criteria
- Step 05
Decide on anomalies, omissions and exceptions
Output
Decisions and human review
verifiedrejectedpending_review
Each case is returned as verified, rejected or pending_review (needs human review), and every field records which document and value it was based on. If any step needs a human check, the case goes to your reviewers.
Documents it reads
Documents it readsand the criteria it applies.
Claim form
Medical or accident records
Policy information
Customer information
Example review criteria
Illustrative only. In practice you write your own criteria as sentences.
policy.md
- 1.The insured person on the claim form must match the patient on the medical record.
- 2.The date of the incident must fall within the policy period.
- 3.If a document required for the claimed item is missing, send the case to human review.
Use case
Other review work,same approach.
01
Automate KYB document review for business onboarding
An AI agent checks business registration, corporate registry extracts, representatives and shareholders, cross-checks external data and AML watchlists, and decides approve, reject or human review.
Learn more →02
Automate corporate telecom subscription review
An AI agent cross-checks business registration, incorporation documents, signatory ID, power of attorney and the service application, verifies signing authority and decides against your subscription rules.
Learn more →04
Automate vendor onboarding document verification
An AI agent cross-checks a certificate of good standing, bank verification letter and beneficial ownership certification, validates the address, screens AML watchlists and decides each vendor case.
Learn more →FAQ
Frequently asked questions
Common questions about using ARGOS Omni for this review.
Which file types can it read?
PDF, DOCX, XLSX, PPTX, images (JPG, PNG, WEBP, TIFF and more), TXT, Markdown, CSV, HTML and EML, up to 100MB in total per case.
How does it connect to our systems?
Submit documents and fetch results through the API. Results come back as JSON in the structure you define, and are also available as a dashboard report and PDF.
Sales
Check whether Omni fits your review work.
Tell us which reviews your team does by hand today and the criteria behind them, and we will set up a test project with those criteria.
Ready to talk?We'll orchestrate your plan with agents.
Every deployment starts with a 20-minute meeting. Share the policies and plans that shift with your business and the operating model you need — we'll deliver an agent orchestration that fits.
Need help? Ask ARGOSAgent.
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