LiveCS—02

VertexAn AI claims assistant that reads 40,000 documents a day

Client
National general insurer
Industry
Fintech & BFSI
Platforms
Web · Cloud
Timeline
5 months · 2026
vertex.appQUEUEClaim #48213Claim #48207Claim #48199Claim #48186Claim #48170Claim #48162Claim #48213Is the hospitalisation in claim #48213covered by the policy?Yes. Section 4.2 covers in-patient treatmentover 24 hours. The discharge summary shows athree-day stay, and room rent of ₹6,500 a dayis within the ₹7,000 limit.[1] Policy wording[2] Discharge summary[3] Hospital billAsk about this claim…SOURCESPolicy wording§4.2Discharge summaryp.2Hospital billline 6Confidence0.93Above review threshold

01The challenge

Claims handlers spent most of their day reading medical bills, survey reports and policy wordings. Turnaround times were rising, and every new hire took months to learn the rules.

02Our approach

We began with an evaluation set of 1,200 real, anonymised claims and agreed accuracy thresholds with claims leadership before writing any production code.

The system combines OCR, structured extraction and retrieval over policy wordings, so the assistant answers handlers' questions with citations. Low-confidence cases go to people automatically, and every decision is logged for audit.

03The outcome

Handlers now start every claim with a pre-filled summary and cited evidence, and spend their time on judgement rather than reading.

04Results

faster claim triage
62%
documents processed every day
40,000
field-level extraction accuracy
94%

05What we built

Inside Vertex

  • 01OCR and structured extraction for 30+ document types
  • 02Retrieval over policy wordings with citations
  • 03Confidence scoring with human review
  • 04Evaluation dashboard tracking accuracy weekly
  • 05Private deployment inside the insurer's cloud
Hands taking notes beside a laptop during a working session
Fintech & BFSINational general insurer

06Architecture

How it fits together.

A simplified view of the production system. Client-specific details are omitted.

System architecture · simplifiedCS—02
PEOPLECLIENT CLOUD · PRIVATEClaims portalReactHuman reviewLow-confidence casesAPIFastAPIOrchestratorPrompts · guardrailsOCR & extraction30+ document typesDocument storeObject storageRetrieverHybrid searchVector indexpgvectorLLMPrivate endpointEvaluationWeekly test suitesAudit & metricsEvery decisionCore componentData storeNetwork boundary
AI
LLMsEmbeddingsOCR
Backend
PythonFastAPIPostgreSQLpgvector
Frontend
ReactTypeScript
Cloud
AWSPrivate networking
“This isn't a demo. It is in production, audited, and trusted by our claims team every single day.”
Head of Claims Operations · National general insurer

07More work

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