Claims Circuit architecture
AI-native claims operations from intake to payment.
Claims Circuit is the AI-native operating product for claims. It maintains the claim as a persistent business object, applies Warranty Decision Intelligence, orchestrates specialized AI Workers, and brings claims professionals into the loop when judgment, authority, risk, or policy requires them.
Native claim objectAI WorkersHITL Work QueuesGoverned autonomyOptional legacy coexistence
CLAIMS CIRCUIT
One operating model. One connected claim.
Decision-readyOne operating model. One connected claim.
AUTONOMOUS CLAIM JOURNEY
Universal ClaimPERSISTENT OPERATIONAL CONTEXT
Asset + customerCoverage + contract3Cs + repairParts + laborImages + documentsHistory + anomaliesDecisions + actionsOutcome + payment
AI WorkersAnswer · Predict · Act
Claims ProfessionalsReview · Decide · Govern
Enterprise SystemsERP · DMS · CRM · Payment
Warranty Decision IntelligencePowered by the Circuitry.ai Decision Intelligence Platform: decision models, controllers, guidance, data, orchestration, HITL, audit, and learning.
THE CLAIMS OPERATING MODEL
Claims Circuit is where claims operations run. The Autonomous Claim Journey is how each claim moves.
This separation keeps the architecture clear: the Circuit is the persistent operating product; the Journey is the execution path; AI Workers perform specialized work; humans and enterprise systems participate whenever the journey requires them.
| Architecture element | Purpose | Claims example |
|---|---|---|
| Claims Circuit | Persistent AI-native claims operating product. Owns claim state, workspaces, work queues, decisions, workers, integrations, audit, and outcomes. | The operating environment for claim intake through payment and close. |
| Autonomous Claim Journey | Orchestrates execution over time. Responds to events and coordinates the next best work across AI, people, and systems. | Intake → Validate → Understand → Score → Decide → Resolve → Pay → Learn. |
| Decision Circuits | Reusable governed decision systems inside the Claims Circuit. | Eligibility, repair validation, claim scoring, authorization, payment verification. |
| AI Workers | Perform specialized decision work. Advisors answer, Analysts predict, Agents execute. | Warranty Advisor, Service Advisor, Parts Advisor, Claim Scoring, Intake, Email/Voice, Virtual Inspection. |
| Human-in-the-Loop | Provides judgment, authority, oversight, and exception handling. | Adjuster review, approval thresholds, overrides, complex or high-value claims. |
| Enterprise systems | Provide or receive data and actions. They participate in the journey without having to own the claim. | ERP, payment, DMS, CRM, data warehouse, communication systems, optional legacy claim admin. |
AUTONOMOUS CLAIM JOURNEY
One connected journey from intake to payment—and learning.
Each stage can invoke one or more Decision Circuits. The journey advances automatically when evidence and authority allow it, and routes the claim to a person when human judgment is required.
THE CLAIM IS THE OPERATING OBJECT
One claim object. Every source. Every decision. Every action.
The Universal Claim preserves the operational context needed by AI Workers and claims professionals across the journey. The legacy admin system is no longer required to be the center of claims work—or even the system of record if the customer chooses to run the claim natively in Circuitry.ai.
Inputs + evidence
Portal / APIEmail / VoiceRepair OrderInvoicesImages / VideoContractsService HistoryThird-party Data
Universal Claim
Claim 024981DECISION-READY STATE
Asset + customerCoverage + contractComplaint · Cause · CorrectionParts + laborImages + documentsHistory + anomaliesEvidence + confidenceDecisions + payment
Persistent stateDecision historyAudit lineageOutcome feedback
Actions + systems
Claims WorkspaceWork QueuesERPPaymentDMS / CRMCommunicationsSupplier SystemsLegacy Admin — optional
SPECIALIZED AI WORKERS
The right intelligence performs the right claims work.
Claims Circuit does not depend on one large general-purpose agent. It coordinates specialized Advisors, Analysts, and Agents, each with defined responsibilities, tools, evidence, permissions, and performance.
A
Advisors
Interpret contracts, coverage, policy, 3Cs, repair logic, parts, service knowledge, and evidence. They answer what is known and explain why.
Answer + guide↗
Analysts
Score claims, detect anomalies, compare expected vs. actual cost, estimate risk, identify patterns, and quantify uncertainty.
Predict + score→
Agents
Capture claims, request missing evidence, update records, communicate decisions, route work, initiate approved actions, and follow through.
Plan + execute◎
Decision Controller
Determines when AI may proceed, when a claim must wait, what authority applies, and when a claims professional must review or approve.
Govern + orchestrateHUMAN-IN-THE-LOOP
People remain in control—without remaining in every step.
Claims professionals supervise the operation through decision-ready work queues. Instead of reconstructing the claim, they receive the evidence, AI assessment, confidence, policy context, and recommended action needed to make the decision.
Claims Adjuster Work Queue
AI routes only the claims that require human judgment, authority, or exception handling.
HIGH
Claim 024981 · repair exceptionValue threshold exceeded · evidence complete
91%REVIEW
Claim 025004 · coverage ambiguityConflicting contract language · Advisor evidence attached
72%HIGH
Claim 025017 · anomalyParts + labor materially above repair profile
88%Decision-ready human review
The adjuster can approve, adjust, deny, request more evidence, override the AI recommendation, or escalate. Every intervention becomes part of the Decision Record and feedback loop.
EvidenceContract, repair, parts, labor, images, history, third-party data.
ConfidenceDecision confidence, anomalies, missing information, and uncertainty.
AuthorityFinancial limits, program rules, approval rights, and escalation thresholds.
AuditAI recommendations, human decisions, overrides, actions, and outcome lineage.
DECISION CIRCUITS INSIDE CLAIMS
Every stage is a measurable decision system.
Claims Circuit can independently manage and improve the decisions that determine whether a claim advances, needs more evidence, requires a person, or can proceed autonomously.
MIGRATION TO AI-NATIVE CLAIMS OPERATIONS
Move the workload first. Retire the legacy claims system second.
Claims Circuit supports a practical transition. Customers can connect existing claims applications, progressively move work and decision authority to AI Workers, make Circuitry.ai the primary operating environment, and retire the legacy claims workload when ready.
Connect + learn
Ingest claim, contract, repair, payment, and historical data. Run AI Workers alongside the current operation and compare decisions to ground truth.
Legacy system remains primaryShift the workload
AI Workers take on intake, validation, evidence gathering, scoring, routine decisions, follow-up, and communications. Humans focus on exceptions.
Work moves to Claims CircuitMake Claims Circuit primary
Create and manage claims natively in Circuitry.ai. Claims flow from intake to payment while enterprise systems receive only the data or actions they require.
Legacy becomes optionalRetire the claims workload
Keep specialized back-office systems only where they add value—or eliminate the legacy claim administration dependency entirely.
AI-native operationsCONNECTED PRODUCT MODEL
Claims Circuit brings the claims products together.
The operating product, journey, decision intelligence, and portfolio intelligence each have a clear role—and work as one architecture.
Autonomous Claim Journey
See how each claim moves through a governed path from intake, validation, scoring, and adjudication through resolution and learning.
Explore the journey →Warranty Decision Intelligence
Understand the decision models, evidence, AI Workers, scoring, governance, and automation that power claims decisions.
Explore WDI →Claims Intelligence
Turn operational claims data into diagnostic, predictive, and prescriptive intelligence for cost, risk, quality, and portfolio outcomes.
Explore Claims Intelligence →CLAIMS OPERATIONS FOR THE AI ERA
Claims Circuit runs the operation. Autonomous Claim Journeys move the work.
Warranty Decision Intelligence powers the decisions. AI Workers perform the work. Claims professionals govern exceptions and high-value decisions. Enterprise systems participate where they add value.