The problem
A regional health insurer's claims team was drowning. 11K weekly claims, 38% needing manual review, a 9-day average cycle, and a backlog that kept growing. Outsourcing wasn't an option because of HIPAA.
What we built
A 3-agent system. A Reader agent pulls structured data out of claim forms. A Validator agent checks against policy and medical-necessity rules using RAG. A Decision agent auto-approves the clean ones and routes the ambiguous ones (with summarized context) to human adjusters. Full audit log on every step.
How it survives production
Structured-output validation on every tool call. RAGAS-gated deploys. Shadow-mode rollout for the first 4 weeks. Human-in-the-loop on any claim above the dollar threshold. Zero compliance incidents wasn't luck. It was the design.
Tech stack
LangGraph Claude 3.5 GPT-4o Pinecone FastAPI PostgreSQL RAGAS LangFuse AWS Bedrock VPC deploy
"Trango didn't pitch us 'AI.' They pitched us a 14-week plan with stop-gates. We hit every one. The system has been live four months and we've expanded scope twice."
SVP, Claims Operations
Top-25 US Health Insurance Carrier