Complete AI Training
Sign inGet my AI kit

Your job's AI kit

Get your AI kit

Tell us who you are and what you do. We show you your kit right away and email you the link: skills, prompts, AI agents, MCP servers and courses for your job.

500+ jobs ready, and we make a kit for any other job. No payment needed to look.

Share

AI agent for insurance claims managers

Reserve Adequacy Review Agent

Keep reserves in line with what the file now shows.

MonitoringAnalysisOperationsInsurance
See how it worksGet access
Reserve Adequacy Review Agent: what goes in, what the agent does and what you get

What it does

A reserve set at the start of a claim can be wrong for months. New medical bills, a repair estimate or a lawyer letter change what the claim will likely cost, but the number stays. This agent reads each open claim's reserve and compares it with the latest documents and estimates. It flags claims where the expected cost differs from the reserve by more than a set margin and drafts a change note with the reason and the evidence. It checks the recommendation against reserving guidelines, such as authority limits. The supervisor approves any change. Edge case: a claim with a new attorney letter is flagged even if the numbers have not changed yet.

How it works

Follow the arrows from top to bottom. The orange dashed arrow is the loop: when a check fails, the agent goes back and tries again.

Start and resultWhat it doesA check on its own workWaits for your OKGoes back and retries
Yes, continueYes, continueApprovedNoNo 1 STARTS WHEN Weekly reserve review 2 USES A TOOL Read open claims and current reserves 3 USES A TOOL Read new documents, estimates and treatment updates 4 DOES Estimate the likely cost from the evidence 5 CHECKS THE RESULT Is the reserve within the margin of the estimate? If not: Skip the claim and recheck when new documentsarrive. Back to step 2. 6 DOES Draft a change note with reasons and evidence 7 CHECKS THE RESULT Does the change fit the reserving guidelines andauthority limits? If not: Route to the right authority level and revisethe note. Back to step 6. 8 YOU APPROVE Supervisor approves the change 9 USES A TOOL Record the change in the claim system 10 RESULT Reserve review log
Read the steps as a list
  1. Weekly reserve review
  2. Read open claims and current reserves
  3. Read new documents, estimates and treatment updates
  4. Estimate the likely cost from the evidence
  5. Is the reserve within the margin of the estimate?If not: Skip the claim and recheck when new documents arrive. Back to step 2.
  6. Draft a change note with reasons and evidence
  7. Does the change fit the reserving guidelines and authority limits?If not: Route to the right authority level and revise the note. Back to step 6.
  8. Supervisor approves the changeThe agent waits here for your OK.
  9. Record the change in the claim system
  10. Reserve review log

How it decides

It estimates likely cost from the newest evidence and flags a reserve that is off by more than the margin.

  • Flag a claim when the estimate differs from the reserve by 15 percent or more
  • Flag claims with a new attorney or a new injury
  • Never lower a reserve without a document that supports it
  • Route above-authority changes to the next level

Make it yours

Every agent is a starting point. You choose these settings for your own situation.

  • Margin that triggers a flag (default 15 percent)
  • Authority limits by role
  • Claim types included
  • Review frequency

What keeps you in control

It always asks you first

  • Supervisor approves every reserve change

Hard limits

  • Never change a reserve itself
  • Never lower a reserve without evidence

It stops when

  • Done: all flagged reserves have a decision
  • Stop: documents are missing and the adjuster is asked for them

Set it up

We guide you through the set-up, step by step

Members get the full set-up guide for this agent. No technical skills needed: you copy, paste and upload.

10 minto set it up in your AI
5 AIsChatGPT, Claude, Copilot, Gemini, Grok
  • One set of instructions to paste into your AI, with the clicks for ChatGPT, Claude, Microsoft 365 Copilot, Gemini and Grok
  • The agent then walks you through connecting your own data, one source at a time
  • A downloadable copy with the flow chart, the rules and the full guide
Get access to this agent

An example run

What happensClaim 4471 has a $6,000 reserve. A new repair estimate arrives at $9,400 and a rental bill adds $900. The agent drafts a change to $10,500. This is above the adjuster's $8,000 authority, so it routes to the supervisor, revises the note, and gets approval. The reserve is changed in the system.

More agents for insurance claims managers

Document handling · Creating

Claim Evidence Timeline Agent

An adjuster-ready chronology where every event is traceable to its source.

7 steps2 checks4 jobs
Administration · Document handling

Subrogation File Assembly Agent

A recovery evidence bundle ready for the recovery team.

7 steps1 check2 jobs
Quality control · Risk management

Claim Payment Document Reconciliation Agent

Every claim payment goes to the correct, verified payee.

8 steps1 check3 jobs
Document handling · Monitoring

Claims Document Version Agent

A complete version history of every claim document.

8 steps1 check5 jobs