Solutions · Claims Investigation

Agentic AI for SIU & Claims Investigation

Fraud doesn't wait, and neither can your investigators. BlackGrid puts an AI co-pilot on the SIU desktop: it assembles the claim, prior-loss history, notes, and documents into one permissioned view, surfaces what doesn't line up — each finding cited to its source — and routes every consequential call to a human. Faster reviews and a stronger paper trail, not a trade between the two.

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Why it's hard today

The blockers between pilots and production.

Hours lost to file assembly

Before judgment can begin, investigators cross-reference the policy, prior claims, adjuster notes, and documents by hand across systems that don't talk to each other.

Defensibility is non-negotiable

Every referral, denial, or payment hold has to withstand scrutiny — from the file, the regulator, or litigation. A black-box lead you can't explain is worse than no lead.

Tools that don't fit the desktop

Adoption dies when a tool demands a new process. What sticks is an assistant that meets investigators inside the case they are already working.

Where agents pay off

Claims Investigation workflows, worked end to end.

Claim & claimant cross-referencing

Surface related claims, duplicate losses, and connected parties across the book — each link anchored to the record it came from, ready for the file.

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Investigation package assembly

Pull the policy, history, notes, and documents into one permissioned view and draft the referral package — so the investigator starts from a built case, not a blank page.

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Red-flag triage with citations

Flag the inconsistencies that matter — a date that doesn't line up, a staged-loss pattern — with a confidence signal and a source, not a black-box verdict.

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Human-owned dispositions

Refer, escalate to SIU, or clear — the recommendation is assembled; the experienced investigator makes the call, and the decision is logged.

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Built for your regulators

Governance is the product, not the paperwork.

SIU work is regulated and adversarial: unfair-claims-practices statutes, state SIU and anti-fraud requirements, and the prospect of litigation all assume you can show how a determination was reached. The NAIC AI Model Bulletin adds an expectation of governed, tested, documented AI. BlackGrid keeps a human accountable for every consequential decision and produces the cited, time-stamped trail that makes a determination defensible — by construction.

Under every workflow sits the same foundation: one governed context layer feeding every agent, human checkpoints on consequential actions, and a complete audit trail on everything. See how the layer works.

Frequently asked questions

Does agentic AI replace SIU investigators?

No — it empowers them. The agent compresses hours of manual research into minutes, but the experienced investigator applies judgment, builds the case, and owns every disposition. The goal is to free investigators for the work only they can do, not to automate it away.

Is the output defensible in a regulated, litigated environment?

That is the point. Every finding is anchored to the source record it came from, every consequential decision runs through a human checkpoint, and the whole investigation — context drawn, leads surfaced, approvals, actions — is captured as a time-stamped, exportable trail you can put in the file or in front of a regulator.

Will it fit our existing case and claims systems?

Yes. BlackGrid is a layer over the systems you already run — policy admin, claims, case management, documents. The agent works inside the existing case rather than asking investigators to learn a parallel tool, which is what makes it stick.

Bring us a real claims investigation workflow.

We'll show it grounded, supervised, and auditable end to end.

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