Governance & Controls
Automation policies, model governance, and compliance settings
Claims above this amount require HITL review
Claims with fraud score above this require HITL
Region-specific Controls
Routes claims to STP or HITL based on risk assessment
Detects potential fraud indicators in claims
Calculates settlement amounts based on coverage
Explainability Requirement
Key factors are logged for all AI decisions. Decision rationale is captured in audit trail.
Immutable Event Log
All events stored with tamper-proof audit trail
PII Minimisation
Personal data minimised in logs and traces
Role-based Access
Evidence and data access controlled by role
High Impact Decision Routing
High impact decisions require human validation before processing
Override Reasons Mandatory
All AI recommendation overrides require documented justification
Queue & SLA Monitoring
Real-time monitoring of adjuster queues and SLA compliance
"AI recommends. Human decides."