Guide
How a role adapter could support claims review
A claims role adapter is designed to summarize a claim file against the relevant policy terms and draft the questions an adjuster would ask next. Adjusters make every coverage decision. The adapter drafts; it does not decide. This is an illustration, not a customer deployment.
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What each layer carries
The base model brings general language and reasoning. The company adapter carries policy wordings, coverage rules, claims procedures, and your terminology. The role adapter tunes behavior to the tasks, formats, and limits of the claims function.
What the adapter is designed to do
- Summarize a claim file against the relevant policy terms.
- Draft the questions an adjuster would ask next.
Both outputs are drafts for an adjuster to read, correct, or discard.
Where people stay in the loop
- Adjusters make every coverage decision.
- Policy owners approve the material the adapter learns from.
- Your reviewers test each new adapter version on examples you choose, and it is activated only when you approve it.
Because the adapter drafts and a person decides, a wrong draft is a quality problem to catch in review. It is not a wrong decision already made.
Why a role adapter, not only a company adapter
The company adapter gives every team the same grounding in your products and terms. It does not know what a claims file looks like or what an adjuster needs on the first read. The role adapter is where the claims function gets its tasks, formats, and limits.
A walk through one file (illustrative)
Suppose a property claim arrives with a claim form and an adjuster's notes. The adapter could draft a short summary that lines the reported loss up against the policy sections that look relevant. It could also propose follow-up questions, such as whether the date of loss falls inside the policy period.
The adjuster reads the draft against the file, corrects it, and decides. This covers drafting for internal use. What is sent outside the company is a choice for your team.
What to settle before starting
Decide which claim types are in scope and which documents are approved material. Decide which outputs stay internal drafts. Decide what your security and model risk reviewers need to see before anything is used.
The role layer is a product design today. Gpodz Compute is pre-launch, and no customer deployment is in production. Which layers are available to your organization is confirmed in writing during scoping.
Questions on this topic
Would the adapter decide claims?
No. In this design the adapter drafts and adjusters decide. Every coverage decision stays with a person.
What material would it learn from?
Material your company approves, such as policy wordings, coverage rules, claims procedures, and terminology. Your team selects it.
What happens when policy wordings change?
The new wordings go into a new adapter version. Your reviewers test it before it is activated, and the previous version is designed to be restorable.
Is a claims adapter running at any insurer today?
No. Gpodz Compute is pre-launch and has no customer deployment in production. This page is an illustration of the design.
Talk through a claims workflow.
Bring one claim type and the review it needs to pass. We will say how the layers would apply.