AI Straight-Through Processing Agent

How Cassidy automates Straight-Through Processing using AI

Step 1: Trigger on new claim or policy request

The Workflow activates when a claim is submitted or a policy servicing request arrives—whether from a web portal, email, agent system, or ACORD/EDI feed.

Step 2: Extract and normalize data

Cassidy uses intelligent document processing to pull key fields from PDFs, images, and unstructured text, then enriches the record with policy details, coverage limits, and external data sources.

Step 3: Validate coverage and eligibility

The Workflow checks the claim or request against policy terms, endorsements, deductibles, and underwriting rules—flagging any coverage gaps or eligibility issues.

Step 4: Screen for fraud and risk

Cassidy applies fraud detection rules and risk scoring, comparing against known patterns and external databases. Cases below confidence thresholds are automatically routed for Human-in-the-Loop review.

Step 5: Make the decision

For standard cases that pass all checks, Cassidy approves the claim or issues the policy change. Complex or high-severity cases are escalated to adjusters or underwriters with pre-populated context and recommended actions.

Step 6: Execute settlement and communications

Approved claims trigger payment authorization and disbursement. Policy changes generate updated documents and ID cards. Automated notifications keep policyholders informed at every step.

Step 7: Log audit trail and update KPIs

Every action, decision rationale, and data point is captured in a complete audit trail. STP rates, cycle times, and exception volumes flow to dashboards for continuous monitoring and optimization.