ARIS – Agentic Claims Manager for Health Insurance

ARIS Professional Services helps health insurance companies implement, integrate, and operationalize Agentic AI-powered health claims management workflows on AWS.

This professional services engagement supports the deployment, configuration, integration, and production enablement of ARIS, an Agentic Claims Manager built on LUMIQ.AI’s LiteCone.ai platform.

Based on the proposed solution architecture, ARIS uses AWS services including Amazon Bedrock, Amazon Textract, Amazon Elastic Container Service (Amazon ECS), Elastic Load Balancing, Amazon Simple Storage Service (Amazon S3), Amazon DynamoDB, Amazon Elastic Container Registry (Amazon ECR), AWS Secrets Manager, Amazon CloudWatch, AWS Identity and Access Management (AWS IAM), and Amazon Virtual Private Cloud (Amazon VPC).

ARIS supports health claim adjudication by combining document intelligence, policy and member validation, admissibility assessment, medical adjudication, financial adjudication, workflow orchestration, and AI-assisted decision support.

The solution processes claim forms, supporting documents, policy information, hospital information, historical claim records, fraud indicators, past adjudications, and claim guidelines. It helps claims teams identify and correlate relevant information across multiple documents and internal or external data sources.

ARIS supports the following health claims activities:

Claim form and supporting document processing, document identification, classification and extraction, document completeness assessment, policy, member and benefit validation, underwriting exclusion and waiting-period checks, hospital validation including blacklist checks, claim admissibility assessment, medical adjudication, financial adjudication, historical claim and fraud-flag analysis, review of previous adjudications, medical reasoning-chain establishment, correlation of symptoms, investigations, consultations, diagnosis and treatment, discharge summary and medical report analysis, length-of-stay validation, payable amount calculation, identification of exclusions and non-payable items, tariff validation and adjustment, deduction calculation, benefit sub-limit assessment, co-payment calculation, human-in-the-loop review and monitoring, final decision support, and integration with downstream systems of record.

ARIS helps claims teams manage large volumes of information while reducing repetitive manual effort. It supports consistent claim assessment, faster response to claim guideline changes, scalability during seasonal or unexpected claim-volume peaks, and improved visibility into AI-generated recommendations.

The proposed architecture deploys LiteCone.ai frontend and backend application services using Amazon ECS within an Amazon VPC and private subnet. Elastic Load Balancing routes incoming user requests to the application services.

Amazon Bedrock supports the AI capabilities used for claim analysis, reasoning, correlation, and decision support. Amazon Textract supports the extraction of text and structured information from claim forms, medical reports, discharge summaries, invoices, policy documents, and supporting records.

Amazon S3 supports document and data storage, while Amazon DynamoDB supports application persistence and workflow-related information. Amazon ECR manages the container images used by the solution. AWS Secrets Manager manages credentials and application secrets, AWS IAM controls access and permissions, and Amazon CloudWatch supports application monitoring, logging, and operational visibility.

The solution can integrate with claims workflow systems, policy administration systems, document management platforms, hospital databases, fraud data sources, payment systems, and downstream systems of record through inbound and outbound APIs, messaging queues, or event-based integrations.