Architecture Example

Claims classification and replacement decision workflow

This architecture example shows how an AI-assisted claims process could route a submission, gather decision context, record confidence, and require review rather than treating model output as an automatic business decision.

Workflow design Human-review path No deployment claim

Problem

A claim may require different expertise and evidence depending on the item, coverage, repair history, price, and anomaly signals. A useful system must organize that context without hiding uncertainty or accountability.

Constraints

Policy rules, historical data, pricing, parts availability, fraud signals, and customer records may be incomplete or conflict. Decisions need traceability, access controls, validation, and escalation to an authorized person.

Approach

Normalize the submission, classify it into a specialized workflow, retrieve permitted decision context, compare repair and replacement paths, calculate confidence, log the basis for the recommendation, and route uncertain or consequential cases to human review.

Claims workflow from intake and classification through specialized analysis, validation, logging, and human review — Architecture example showing decision stages and controls; it does not represent a named or deployed customer system.

Engineering

Structured intake normalization and category routing.
Specialized analysis paths for policy, repair history, price, parts, claims history, and anomaly signals.
Confidence thresholds, audit records, validation, and human-review queues.
Feedback paths designed to improve the knowledge base under controlled review.

Validation / Results

The workflow diagram verifies that decision controls and review paths are represented in the design.
The example demonstrates architecture reasoning, not a production integration test.
No customer system, operational volume, savings, or automated approval outcome is asserted.

What This Demonstrates

AI workflow decomposition around a real business decision.
Human oversight, auditability, confidence handling, and exception routing.
Separation of model recommendations from authorized operational decisions.
Integration-aware planning across data, policy, and workflow systems.

Relevant HerbDev Services

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Explore Deeper

This example is intentionally self-contained. There is no underlying client project or private deployment being implied.

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