Agentic artificial intelligence system

Abstract

An agentic artificial intelligence system processes insurance claims, medical claims, financial transactions, and sales leads by receiving and preprocessing claimant, patient, transaction, and prospect data to standardize formats, remove sensitive identifiers, and enrich records. It uses machine learning, deep learning, natural language processing, and computer vision to analyze both structured and unstructured data, identify errors, inconsistencies, or fraudulent patterns, verify eligibility and compliance, and assign relevant codes based on historical and contextual information. The system calculates expected payouts or reimbursements, assesses transaction feasibility, and generates risk scores while adapting its predictions to market conditions, contractual factors, or clinical guidelines. A multi-agent framework coordinates specialized agents for eligibility verification, coding, pricing, fraud detection, and sales outreach, supporting multi-channel communication, lead prioritization, and natural language generation of outreach messages and decision-making explanations. Continuous learning is achieved via retraining, feedback loops, federated learning, and blockchain-based recordkeeping, ensuring secure, transparent, and compliant operations across multiple domains.