How to Build a Claims Processor AI Agent

Processing claims is a complex and time-consuming undertaking. Extracting the information, analyzing the document, and exporting the data require multiple stages of labor. 

For insurance companies and other entities that handle claims and invoices, the process is not just time-intensive and error-prone. Processing claims is also expensive, and requires significant employee labor. 

However, with the emergence of AI agents, companies can now streamline the processing of insurance claims, receipts, and invoices.

In the following blog, we’ll show you how to build a claims processor AI agent, and explain the benefits it offers teams.

Claims Processing: Challenges & Methods

Processing statements such as insurance claims, receipts, and invoices is inherently difficult due to the wide variety of formats and the unstructured nature of the data involved. Each document comes from a different source, follows different layouts, and contains varying terminology. 

Unlike structured data in databases, these documents often include scanned images, handwritten notes, or photographs. This unstructured data requires advanced techniques like optical character recognition (OCR) and natural language processing (NLP) to interpret accurately. 

Another significant challenge is the need for data validation. The manual effort required to compare and validate this information slows down the process and introduces the risk of human error.

Additionally, most claims workflows are fragmented — often involving multiple departments, systems, and review stages. This makes balancing timeliness and customer satisfaction more difficult. 

How AI Agents Transform the Claims Process

AI agents can streamline the processing of statements such as insurance claims, invoices, and receipts by automating data extraction and classification. These documents often come in a variety of formats—scanned PDFs, images, or handwritten notes—which makes consistent interpretation difficult. 

AI agents equipped with advanced OCR and NLP capabilities can accurately extract relevant fields like dates, amounts, policy numbers, and itemized details. This eliminates the need for manual entry, speeds up the initial processing step, and reduces human error.

Beyond data extraction, AI agents play a critical role in validation and decision-making. They can cross-reference extracted information against policy documents, pricing databases, or previous records to ensure consistency and legitimacy. 

For example, in processing an insurance claim, an AI agent might check whether the reported damage aligns with coverage terms or identify potential fraud by comparing the claim to past patterns. Similarly, for invoices and receipts, AI agents can flag discrepancies in charges, detect duplicates, or validate payment terms—tasks that would otherwise require extensive human review.

Finally, AI agents enhance communication and workflow orchestration throughout the claims lifecycle. They can interact with customers or vendors through chat or email, provide real-time updates, and escalate issues that require human oversight. 

Internally, they can route documents to the appropriate teams, trigger approvals, and keep systems synchronized across departments. This end-to-end automation not only reduces processing time but also improves accuracy, transparency, and customer satisfaction—making AI agents a valuable asset in any organization that deals with high volumes of complex documentation.

AI Agent Overview: Claims Processor AI Agent

The Claims Processor Agent allows you to upload insurance claims, receipts, invoices, and other statements. The AI agent automatically converts the uploaded statements into parsable JSON. 

The JSON is displayed in an output box. The JSON is also outputted into a Google Sheet of the user’s choosing. Users can leverage the structured JSON data in their own apps and databases.

Agent Workflow

In the next section, we’ll show you how to build the Claims Processor AI Agent from scratch. 

Claims Processor AI Agent: How to Build It

As a first step, let’s add a file upload node so users can upload their claims, invoices, and other statements. 

Go to the inputs category and select Files. 

Place the file upload node on the canvas. The file upload node uses OCR to extract the data from the document in an unstructured format. Change the name to “Claims, Receipts, and Invoices”. 

Next, go to the LLMs category and select OpenAI. 

Set the LLM model to GPT-4.1.

Enter the following text into the Instructions field:

You extract data from insurance claims document into a JSON.

Data to extract from documents:

Respond under the following schema

<JSON_Schema>

{{

"type": "object",

"properties": {{

"document_type": {{

"type": "string",

"enum": ["claim_form", "invoice", "receipt", "insurance_policy"]

}},

"claim_form": {{

"type": "object",

"properties": {{

"claimant": {{

"type": "object",

"properties": {{

"name": {{ "type": "string" }},

"address": {{ "type": "string" }},

"contact_details": {{ "type": "string" }},

"policy_number": {{ "type": "string" }}

}}

}},

"incident": {{

"type": "object",

"properties": {{

"date": {{ "type": "string", "format": "date" }},

"time": {{ "type": "string" }},

"location": {{ "type": "string" }},

"description": {{ "type": "string" }}

}}

}},

"claim_type": {{ "type": "string" }},

"claim_amount": {{ "type": "number" }},

"supporting_documents": {{

"type": "array",

"items": {{ "type": "string" }}

}},

"signature": {{ "type": "string" }},

"submission_date": {{ "type": "string", "format": "date" }}

}}

}},

"invoice": {{

"type": "object",

"properties": {{

"invoice_number": {{ "type": "string" }},

"date_of_issue": {{ "type": "string", "format": "date" }},

"vendor": {{

"type": "object",

"properties": {{

"name": {{ "type": "string" }},

"contact": {{ "type": "string" }}

}}

}},

"customer": {{

"type": "object",

"properties": {{

"name": {{ "type": "string" }}

}}

}},

"line_items": {{

"type": "array",

"items": {{

"type": "object",

"properties": {{

"description": {{ "type": "string" }},

"quantity": {{ "type": "number" }},

"unit_price": {{ "type": "number" }},

"total": {{ "type": "number" }}

}}

}}

}},

"subtotal": {{ "type": "number" }},

"tax": {{ "type": "number" }},

"total_amount": {{ "type": "number" }},

"payment_terms": {{ "type": "string" }},

"due_date": {{ "type": "string", "format": "date" }},

"reference_numbers": {{

"type": "array",

"items": {{ "type": "string" }}

}},

"bank_details": {{ "type": "string" }}

}}

}},

"receipt": {{

"type": "object",

"properties": {{

"receipt_number": {{ "type": "string" }},

"date_time": {{ "type": "string", "format": "date-time" }},

"merchant": {{

"type": "object",

"properties": {{

"name": {{ "type": "string" }},

"location": {{ "type": "string" }}

}}

}},

"items": {{

"type": "array",

"items": {{

"type": "object",

"properties": {{

"description": {{ "type": "string" }},

"quantity": {{ "type": "number" }},

"price": {{ "type": "number" }}

}}

}}

}},

"total_amount_paid": {{ "type": "number" }},

"payment_method": {{ "type": "string" }},

"tax_details": {{ "type": "string" }},

"related_claim_or_policy": {{ "type": "string" }}

}}

}},

"insurance_policy": {{

"type": "object",

"properties": {{

"policy_number": {{ "type": "string" }},

"policyholder": {{

"type": "object",

"properties": {{

"name": {{ "type": "string" }},

"address": {{ "type": "string" }},

"contact": {{ "type": "string" }}

}}

}},

"coverage_details": {{

"type": "object",

"properties": {{

"types": {{

"type": "array",

"items": {{ "type": "string" }}

}},

"limits": {{ "type": "string" }},

"exclusions": {{ "type": "string" }}

}}

}},

"effective_date": {{ "type": "string", "format": "date" }},

"expiry_date": {{ "type": "string", "format": "date" }},

"premium_amount": {{ "type": "number" }},

"payment_schedule": {{ "type": "string" }},

"beneficiaries": {{

"type": "array",

"items": {{ "type": "string" }}

}},

"endorsements": {{ "type": "string" }},

"agent": {{

"type": "object",

"properties": {{

"name": {{ "type": "string" }},

"contact": {{ "type": "string" }}

}}

}},

"terms_and_conditions": {{ "type": "string" }}

}}

}}

}},

"required": ["document_type"]

}}

</JSON_Schema>

Then enter the following text into the Prompt field.

Files provided by user:

<Files>

Claims, Receipts, Invoices

</Files>

Search the web to complement the data collected. You can call the web search tools several times to collect data. Always respond on the schema requested, no matter if it's empty

With this guidance, the LLM can take the unstructured data from the claim or invoice, and turn it into structured JSON.  

After setting up the LLM, click on the Apps category and select Write to Sheet. 

Drag the node onto the canvas.

Then adjust the settings. Under Connect GSheets, choose New Connection. Then select your Google account.

Then choose the data source. In this case, it will be your OpenAI LLM.

Next, select the Google Sheet to write to. Also, select the specific sheet in the spreadsheet. 

Under Outputs, select Output.

Drag the Output node onto the canvas and connect it to your Google Sheets node. 

Now drag another Output node onto the canvas and connect it to your LLM node.

Now click on the Export tab. 

Give your AI agent a name and a description. 

Save the UI interface. 

Then click on the link to launch the web app. 

Now you can use the AI agent from the simple UI. Upload a claim and receive the structured data back in JSON.

You can leverage the JSON in databases, backend actions, and records systems to complete claims processing.

You can also change the type of UI in the drop down to Batch. 

This will allow you to analyze multiple claims at once.  

Batch interface can speed up bulk processing of claims. 

Build the Claims Processor Agent Now!

Processing claims, invoices, and other statements is time-intensive, complicated, and requires significant labor. 

But with the Claims Processor Agent, you can process financial statements in bulk and structure them as JSON to quickly process claims.

Sign up for a free account with Stack AI to start building the Claims Processor AI Agent right now!