Financial Eligibility Assessment Agent
Automate financial checks to ensure compliant coverage eligibility
Description
Challenge:
Manual financial eligibility checks are time-consuming, prone to errors, and may miss inconsistencies or fraudulent submissions. Misjudging affordability or sum assured multiples can result in over-insurance, financial misrepresentation, or compliance violations, creating risk for the insurer.
How It Works:
The Financial Eligibility Assessment Agent collects declared income, occupation, and supporting financial documents, then validates these against internal records and external sources such as credit bureaus, tax authorities, and employment databases. It applies product-specific financial underwriting rules, including income-to-sum assured ratios, affordability thresholds, and debt-to-income checks. The agent classifies applicants as Eligible, Partially Eligible (requires additional evidence), or Ineligible and triggers automated workflows for approval, document requests, or declines. All assessments are fully auditable to ensure compliance, consistency, and transparency.
Benefits:
90–95% accuracy in verifying financial disclosures
70% reduction in manual financial eligibility checks
30–40% fewer misrepresentation-related declines post-policy issuance
Real-time financial eligibility determination (<2 minutes)
Transparent, auditable, and compliant underwriting decisions
Reduced fraud, over-insurance risk, and manual workload
Features
This agent standardizes, validates, and scores financial eligibility, ensuring automated, consistent, and compliant underwriting decisions across life and health insurance products.
Features & Capabilities:
Data Capture: Collect declared income, occupation, and financial documents
Document Retrieval: Fetch salary slips, bank statements, tax returns, and employment proofs
Rule Application: Apply product-specific income-to-sum assured multiples, affordability thresholds, and underwriting rules
External Validation: Cross-check with credit bureau, tax, and employment databases
Classification: Eligible / Partially Eligible / Ineligible
Action Triggers: Approve, request additional documentation, or decline with reasoning
Consistency Checks: Compare declared vs. verified income and flag discrepancies
Operating Blueprint
Knowledge Sources:
Income Verification Guidelines (per product/LOB)
Tax Records & Income Declaration Rules
Financial Underwriting Manuals
Credit Bureau and Scoring Models
Employment Verification Databases
Regulatory Affordability Guidelines
Business Rules:
Income-to-Sum Assured Ratio: Maximum allowed multiples per product; exceed → flag or adjust
Minimum Income Threshold: Auto-decline if below product-specific minimum
Consistency Check: Mismatch between declared and verified income >20% triggers review
Debt-to-Income Ratio: Flag if obligations exceed 50% of net income
Occupation-Specific Affordability: Stricter rules for high-risk/unstable occupations
Credit Score: Must meet minimum threshold; otherwise route for manual underwriting
Source Verification: Confirm income legitimacy; reject unverifiable sources
Documentation Completeness: Missing financial proofs auto-trigger requests
Tool Workflow:
Input Capture: Applicant submits income and financial documents
Data Retrieval: Fetch internal and external verification data
Rule Application: Apply financial eligibility and affordability checks
Consistency Check: Compare declared vs. verified data
Outcome Classification: Eligible / Partially Eligible / Ineligible
Action Execution: Approve, request documents, or reject
Audit Logging: Store full decision trail for governance and compliance
Badges
Classification
Capabilities
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