AI Process Orchestration for Claims Workflow

Azati implemented and operates an AI orchestration layer for a regional bank, integrating AI agents into existing loan amendment and claims workflows across legacy systems while managing automation, compliance, and ongoing optimization.

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more cases processed

61%

reduction in average case resolution time

100%

of AI decisions logged with full audit trail

All Technologies Used

Python
Python
Elasticsearch
Elasticsearch
OpenAI
OpenAI
Oracle DB
Oracle DB
REST APIs
REST APIs
Apache Airflow
Apache Airflow
Docker
Docker
Azure
Azure

Motivation

The bank’s loan amendment process required coordination across three internal systems, with significant manual effort at each handoff. Case officers spent most of their time on data retrieval, cross-system validation, and documentation rather than judgment-based review. The bank needed to automate this coordination layer without replacing existing platforms, leading to the adoption of a managed AI service to ensure continuous governance and regulatory compliance.

Main Challenges

Challenge 01
Multi-System Coordination Without Platform Replacement

Three legacy platforms with different data models and no native integration capability. The solution required an orchestration layer that could read from and write to all three systems, using RPA bridges where direct APIs were unavailable.

#1
Challenge 02
Regulatory Sensitivity

Loan amendment decisions in the bank's jurisdiction required full explainability and human sign-off at defined decision points. The AI could assist and prepare, but never decide autonomously on regulated actions.

#2
Challenge 03
Process Variability and Edge Cases

Loan amendment cases varied significantly by product type, customer segment, and amendment reason. A rigid rule-based automation would fail on edge cases. The system needed contextual reasoning, not just data transfer.

#3
Challenge 04
Internal Compliance Team Skepticism

The compliance and risk teams were concerned about AI involvement in regulated workflows. The rollout required a transparent governance model, showing exactly what AI did, when, and with what confidence, before they would approve expansion.

#4

Our Approach

Orchestration-First
Azati designed an AI orchestration middleware that coordinates data flow between the three existing platforms, retrieving, validating, enriching, and routing case data, while leaving all core systems untouched. RPA bridges handle systems without direct API access.
Human-in-Loop at Regulated Decision Points
The AI prepares cases fully, pulling documents, cross-validating data, flagging discrepancies, and generating a structured summary, but a human officer makes and records all regulated decisions. The AI reduces preparation time, not accountability.
Managed Governance as Core Deliverable
Azati operates the AI layer with full logging, exception monitoring, and monthly compliance reporting as standard. Every AI action produces a structured log entry consumable by the bank's internal audit team and external regulators.
Incremental Expansion Model
Automation started with the most standardized case type (standard term amendments) and expanded to new categories each quarter as accuracy and compliance team confidence grew.

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Solution

01

AI Case Intake and Data Aggregation

On case creation, the orchestration layer automatically retrieves relevant data from all three systems, account history, document archive, compliance registry, and assembles a structured case package for officer review.
Key capabilities:
  • Cross-system data retrieval via API and RPA
  • Automated document collection and linking
  • Data validation and discrepancy flagging
  • Structured case summary generation
02

AI-Assisted Eligibility and Risk Assessment

AI analyzes the assembled case data against eligibility rules and risk criteria, generates a structured assessment, and flags any conditions requiring escalation, before the officer opens the case.
Key capabilities:
  • Rule-based and ML eligibility screening
  • Risk signal identification and annotation
  • Automated escalation triggers
  • Assessment narrative generation for officer review
03

Workflow Orchestration and Status Coordination

AI agents manage status updates, approval routing, and notifications across the three systems, ensuring case state is synchronized without manual cross-system entry.
Key capabilities:
  • Cross-platform status synchronization
  • Automated approval routing
  • SLA tracking and escalation alerts
  • Exception handling with human fallback
04

Compliance Logging and Audit Interface

Every AI action in the workflow is logged, what data was retrieved, what assessment was generated, what routing decision was made, and by whom it was approved. Logs are structured for regulator export.
Key capabilities:
  • Immutable per-case audit log
  • Officer action attribution
  • Regulator-ready export (PDF and structured data)
  • Monthly compliance reporting for internal audit

Business Value

Tripled Case Handling Capacity: Case officers handle 3х more cases per day, AI eliminates preparation and cross-system data gathering, leaving only judgment-intensive work.

From Days to Hours: Average case resolution time reduced 61%, from 4.5 business days to under 18 hours on standard amendment types.

Audit-Ready Decision Automation: 100% of AI-assisted decisions carry a full, structured audit log. The bank passed its first post-implementation regulatory review with zero findings related to the AI layer.

Zero Risk to Core Platforms: Zero changes to core banking, DMS, or compliance registry systems, the orchestration layer is entirely external and removable.

Scalable Automation Expansion: Automation coverage grew from one case type at launch to six distinct amendment categories across four quarters of managed operations.

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