AI: Claim Settlement Assistant

Use the Claim Settlement Assistant to improve the efficiency of promotional deduction settlements.

The agent automatically interprets deduction references, identifies the applicable program, finds related accruals, validates balances, and associates the deduction to the correct accrual. Additionally, the agent helps to reduce manual research and resolution of deductions by netting with credit memos. The agent automatically identifies, validates, and accurately applies open credit memos.

Realize these benefits:

Faster and leaner settlements: Less manual work, saving many minutes per transaction.
Greater efficiency at scale: Handle high volumes more effectively.
Fewer errors with consistent decisions: System assistance minimizes mistakes.
Better visibility and auditability: Easier tracking and compliance.
Derive claim type and reason efficiently: Use retrieval augmented generation (RAG) to derive the claim type and reason based on claim attributes.

Set Up

To configure the Claim Settlement Assistant:

Go to Home > Tools > AI Agent Studio > Agent Teams.
On the Agent Teams page, select the Product filter, search for Channel Revenue Management, and click Enter.
Select the Published tab.
Locate the predefined Claim Settlement Assistant workflow agent and click the Download icon in the Actions column.
Open the downloaded JSON file and update the values for WorkflowCode and Name based on your implementation requirements.
Navigate to the Draft tab in AI Agent Studio.
Import the modified JSON file.
After the agent is imported, click the Edit icon in the Actions column. The Claim Settlement Agent page opens.
On the Claim Settlement Agent page, click the Agent Team Settings icon and navigate to the Triggers tab.
Configure the schedule based on your business requirements.
Click Update and then Publish the modified workflow agent.
Once published, the Claim Settlement Assistant workflow agent runs automatically in the background according to the configured schedule.

To configure and use the RAG document:

Go to Home > Tools > AI Agent Studio > Tools.
On the Tools Library page, use the filters to search for the Claim Type Claim Reason mapping document.
Click the Edit Tool.
On the Claim Type Claim Reason mapping document page that opens, click Add in the Documents region. Enter the Name and Description for the document, and then Drag and Drop your RAG file.
Select Ready to Publish from the Status. Click Save.
Navigate to the Scheduled Processes Overview page, search for, and run the Process Agent Documents scheduled process. The uploaded RAG document is now available for use in the claim settlement assistant.

Guidelines

Enable claim approvals to review deductions before they are automatically settled by the Claim Settlement Assistant.
You can customize the workflow agent by modifying the LLM nodes based on your business requirements.
During the initial execution, the workflow agent processes all open deductions created on that day; in subsequent executions, it processes deductions created after the last agent execution.
To monitor workflow execution and review agent schedule details, navigate to Monitor and Evaluation > Activities > Schedules.
Once a deduction has been evaluated by the workflow agent, it isn't re-evaluated in subsequent runs, even if additional data is added later, for example, an updated customer reference or reason.

Agent Process Flow

A scheduled trigger runs at a user-defined frequency and scans all deductions created since the last run. For each deduction, the agent reviews available attributes (for example customer reason, customer reference, and receipt application DFF) to determine the appropriate settlement method.

The agent uses the following settlement decision logic:

Promotional Settlement:
- If the agent detects a program code or name, then it identifies the corresponding program and checks for available accrual balances.
- If the agent detects eligible accruals, then it associates the accruals to the deduction and advances the claim status to Approval Pending or Settlement Pending based on the configured workflow.
Credit Memo Netting: If an open credit memo exists for the same customer with the same customer reference as the deduction, then the agent performs the netting.

The agent performs only one settlement action per deduction based on the data and eligibility checks available during processing.

After the assistant completes processing, its actions are logged as a claim note and an email is sent to the claim owner, even if the association was not successful.

Agent Actions

The following table describes various actions the agent takes in the described scenarios:

Scenario	Agent Action
Single matching program is detected	When the agent identifies a single matching program code or program name, it completes the program association and moves the claim to Approval Pending or Settlement Pending status.
Multiple program codes or names are found in deduction	When the agent identifies multiple programs from the deduction details, it adds a claim note with the identified programs and keeps the claim in Open status for a manual review.
Multiple programs are detected	When the agent identifies multiple valid programs that match the program name provided in the deduction, it adds a claim note listing the matching programs and keeps the claim in Open status for a manual review.
Customer Reference value in deduction matches the program as well as the credit memo.	When the value provided in the customer reference matches both an open credit memo and a program for which there are accruals, then the agent adds a claim note listing the matching program and credit memo and keeps the claim in Open status for a manual review.
A program is detected, however there is insufficient accrual balance	When the agent identifies a single program match but the available accrual balance for the program is less than the required deduction amount to complete the association, then the agent keeps the claim in Open status for a manual review.
A program reference is provided, however, no matching program is detected	When the agent identifies a program reference in the deduction details, but doesnt't detect a matching program, it doesn't complete an association, and keeps the claim in Open status for a manual review.
Open credit memo is detected	When the agent evaluates the customer reference and detects an open credit memo in Accounts Receivable with the required available amount and the same customer reference, the deduction is settled using this open credit memo.
Open Credit Memo detected, however there is an amount mismatch	When the agent evaluates the customer reference and detects an open credit memo in Accounts Receivable with the required available amount and the same customer reference, but finds that the credit memo amount doesn't match the deduction amount, the agent doesn't do the netting and keeps the claim in Open status for a manual review.
There is no program reference and no matching open credit memo	When the agent can't identify any program reference in the deduction details and can't detect any open credit memo in Accounts Receivable with a matching customer reference, it doesn't complete a settlement and keeps the claim in Open status for a manual review.
A match is detected, however a Settlement Method isn't enabled for the Claim Source	When the agent detects a match, but finds that the settlement method isn't enabled for the claim source, the agent doesn't complete a settlement and keeps the claim in Open status for a manual review.
Required setup configuration is incomplete for automated settlement	When the agent detects a match but finds that required setup configurations are incomplete, the agent identifies the list of missing configuration steps and keeps the claim in Open status for a manual review.
Claim status is changed during agent processing	When the agent detects a match and the claim status is changed manually while the agent is processing the claim, the agent stops the settlement to avoid conflicting updates and keeps the claim in Open status for a manual review.
Settlement details are updated manually while agent was processing	When the agent detects a match and the settlement details are changed manually while the agent is processing the claim, the agent stops the settlement to avoid conflicting updates and keeps the claim in Open status for a manual review.

Sample RAG Document

Deduction to Claim Mapping Setup Document Purpose

This document defines the business rules for deriving Claim Type and Claim Reason based on deduction attributes such as:

Business Unit
Bill-to Customer
Settlement Type
Claim Source

Rule Derivation Logic

Claim Type and Claim Reason are determined based on a combination of attributes. If multiple rules match, priority is determined in the following order:

Business Unit + Settlement Type + Claim Source+ Bill-to Customer
Business Unit + Settlement Type+ Bill-to Customer
Business Unit + Settlement Type+ Claim Source
Business Unit+ Settlement Type only
Settlement Type only

Rule ID and Priority	Business Unit	Claim Source	Settlement Type	Bill-to Customer	Derived Claim Type	Derived Claim Reason
1	Specify the name of the business unit.	Deduction	Promotional	Specify the name of the Bill-to customer.	The derived claim type, for example Pricing Adjustment.	The derived claim reason, for example Invoice Discrepancy.
2	Specify the name of the business unit.	Any	Promotional	Specify the name of the Bill-to customer.	The derived claim type, for example Pricing Adjustment.	The derived claim reason, for example Invoice Discrepancy.
3	Specify the name of the business unit.	Any	Nonpromotional	Any	The derived claim type, for example Warranty Claim.	The derived claim reason, for example Return Authorization.

For more information, see: