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AI-Powered Insurance Claims Processing on AWS EKS

AWS EKS Kubernetes Terraform Python MongoDB

🎯 Overview

A production-ready AI-powered insurance claims processing application demonstrating advanced multi-agent AI patterns with LangGraph on AWS EKS. This repository showcases intelligent, autonomous decision-making systems for insurance claims adjudication with fraud detection.

✨ Key Features

  • 🤖 AI-Powered Automation: Intelligent claim review with ML-driven fraud detection
  • 👥 4 Persona Portals: Claimant, Adjuster, SIU, and Supervisor interfaces
  • 📊 Comprehensive Business KPIs: Loss ratio, fraud analytics, processing efficiency
  • 🔍 Smart Fraud Detection: Real-time risk scoring with explainable AI
  • ⚡ Cloud-Native & Scalable: Kubernetes deployment with auto-scaling
  • 🛡️ Enterprise Security: AWS Secrets Manager, RBAC, secure data handling
  • 📈 Production Monitoring: CloudWatch integration with custom metrics

🚀 Quick Start

Prerequisites

# Required tools
- AWS CLI (configured with credentials)
- kubectl (v1.27+)
- Terraform (v1.5+)
- Docker (v20.10+)
- jq

One-Command Deployment

# Clone repository
git clone https://github.com/aws-samples/sample-agentic-insurance-claims-processing-eks.git 

cd sample-agentic-insurance-claims-processing-eks

# Deploy everything (infrastructure + apps + data)
./scripts/deploy.sh

What it does:

  1. ✅ Auto-detects your AWS account ID and region
  2. ✅ Deploys EKS cluster and infrastructure via Terraform
  3. ✅ Builds and pushes Docker images to ECR
  4. ✅ Deploys Kubernetes applications
  5. ✅ Loads 500 sample policies and 100 claims
  6. ✅ Displays application access URL

Deployment Options

# Infrastructure only
./scripts/deploy.sh --terraform-only

# Applications only (skip Terraform)
./scripts/deploy.sh --apps-only

# Custom data volumes
./scripts/deploy.sh --policies 1000 --claims 300

# Load additional data
./scripts/load-data.sh --policies 500 --claims 200 --clear

📱 Application Portals

Access via ALB URL (displayed after deployment):

Portal Endpoint Purpose
Claimant /claimant Submit insurance claims with policy verification
Adjuster /adjuster Review claims, AI risk assessment, approve/deny
SIU /siu Investigate fraud, escalate cases, document findings
Supervisor /supervisor Business KPIs, analytics, performance monitoring

📊 Business Intelligence Dashboard

The Supervisor Portal provides enterprise-grade analytics:

Primary KPIs

  • Loss Ratio: (Incurred Losses + LAE) / Earned Premiums (target: <70%)
  • Expense Ratio: Operating Expenses / Earned Premiums (industry avg: 25-30%)
  • Combined Ratio: Loss Ratio + Expense Ratio (<100% = underwriting profit)
  • Approval Rate: % of processed claims approved
  • Processing Time: Average claim resolution time (current: 2.3 min)
  • AI Accuracy: Fraud detection model performance (94.7%)

Analytics Sections

  1. Financial Performance: Premiums, incurred losses, operating expenses, underwriting profit
  2. Fraud Risk Analysis: High/medium/low risk distribution
  3. Claims Distribution: By type, status, and geographic location
  4. Operational Metrics: Processing efficiency, throughput, uptime

🏗️ Architecture

┌─────────────────────────────────────────────────────────┐
│              Application Load Balancer (ALB)             │
└───────────────────────┬─────────────────────────────────┘
                        │
        ┌───────────────┼───────────────┐
        │               │               │
   ┌────▼────┐    ┌─────▼──────┐  ┌───▼──────┐
   │ Web UI  │    │Coordinator │  │Simulator │
   │ Portal  │    │  (Agent)   │  │          │
   └────┬────┘    └─────┬──────┘  └──────────┘
        │               │
        │         ┌─────┴─────┬──────────┬──────────┐
        │         │           │          │          │
        │    ┌────▼────┐ ┌───▼────┐ ┌───▼────┐ ┌──▼─────┐
        │    │ Policy  │ │ Fraud  │ │  Risk  │ │External│
        │    │  Agent  │ │ Agent  │ │ Agent  │ │  APIs  │
        │    └────┬────┘ └───┬────┘ └───┬────┘ └──┬─────┘
        │         │          │          │         │
        └─────────┴──────────┴──────────┴─────────┘
                        │
           ┌────────────┴────────────┐
           │                         │
      ┌────▼─────┐             ┌────▼────┐
      │ MongoDB  │             │  Redis  │
      │ (Claims) │             │ (Cache) │
      └──────────┘             └─────────┘

Detailed architecture documentation: ARCHITECTURE.md

📚 Documentation

Getting Started

Document Description Audience
Quick Start One-command deployment to get running in 30 minutes Everyone
Deployment Guide Complete deployment instructions with configuration options DevOps, Developers
Demo Guide Interactive 20-30 min demo walkthrough for stakeholders Sales, Product, Executives

System Architecture & Features

Document Description Audience
Architecture Overview System design, components, and data flow Technical teams
Insurance Claims Processing Domain features, persona portals, and workflows Product, Business
LangGraph Agentic System AI architecture and agent coordination AI/ML Engineers

Operations & Production

Document Description Audience
Production Deployment Production checklist and best practices DevOps, SRE
Infrastructure Setup AWS infrastructure provisioning with Terraform Cloud Engineers
Secrets Management Security configuration and credential management Security, DevOps

Demo & Testing

Document Description Audience
Video Demo Guide 4-5 minute recorded demo instructions Marketing, Sales
Human-in-the-Loop Demo Complete demo with human decision workflow Technical demos

File Organization

/
├── README.md                          # This file - project overview
├── ARCHITECTURE.md                    # System architecture and design
├── DEMO_GUIDE.md                      # Interactive demo walkthrough
├── AUTOMATED_DEPLOYMENT.md            # Automated deployment system docs
├── SECURITY.md                        # Security policy and guidelines
│
└── docs/
    ├── DEPLOYMENT_GUIDE.md            # Complete deployment instructions
    ├── INFRASTRUCTURE_SETUP.md        # AWS infrastructure details
    ├── PRODUCTION_DEPLOYMENT.md       # Production best practices
    ├── SECRETS_MANAGEMENT.md          # Security and secrets
    ├── INSURANCE_CLAIMS_PROCESSING.md # Domain features and portals
    ├── LANGGRAPH_AGENTIC_README.md    # AI agent architecture
    ├── VIDEO_DEMO_GUIDE.md            # Video recording guide
    └── DEMO_WITH_HUMAN_IN_THE_LOOP.md # Human decision workflow

🛠️ Technology Stack

Layer Technology Purpose
Orchestration AWS EKS Managed Kubernetes
IaC Terraform Infrastructure as Code
Compute Karpenter Node auto-scaling
Networking AWS VPC + ALB Load balancing & routing
AI Framework LangGraph Agentic workflows
LLM Ollama (Qwen2.5) Local LLM inference
Database MongoDB Document storage
Cache Redis Session & response caching
Backend FastAPI + Python Web services
Monitoring CloudWatch Metrics & logging
Secrets AWS Secrets Manager Credential management

⚙️ Configuration

Environment Detection

The deployment scripts automatically detect:

  • AWS Account ID via aws sts get-caller-identity
  • AWS Region from AWS CLI configuration
  • ECR Registry constructed as {account-id}.dkr.ecr.{region}.amazonaws.com

Manual Override (Optional)

export AWS_REGION=us-west-2
export EKS_CLUSTER_NAME=agentic-eks-cluster
export OLLAMA_MODEL=qwen2.5-coder:7b

Scaling Configuration

# infrastructure/kubernetes/coordinator.yaml
spec:
  replicas: 3
  resources:
    requests:
      cpu: "1000m"
      memory: "2Gi"
    limits:
      cpu: "2000m"
      memory: "4Gi"

📈 Performance Metrics

Metric Value Target
Avg Processing Time 2.3 min < 3 min
Throughput 1000+ claims/day -
AI Accuracy 94.7% > 90%
Fraud Detection Rate 10-15% Industry standard
System Uptime 99.2% > 99%
API Response Time < 200ms < 500ms

🔒 Security

  • ✅ IAM Roles for Service Accounts (IRSA)
  • ✅ AWS Secrets Manager for credentials
  • ✅ Network policies for pod isolation
  • ✅ TLS termination at ALB
  • ✅ RBAC for Kubernetes resources
  • ✅ Container image scanning
  • ✅ CloudWatch audit logging

🧪 Testing & Validation

# Validate deployment
./scripts/validate-deployment.sh

# Run end-to-end tests
./tests/comprehensive-e2e-demo.sh

# Load test data (configurable volumes)
./scripts/load-data.sh --policies 1000 --claims 300 --clear

🐛 Troubleshooting

Common Issues

ECR Authentication Error

aws ecr get-login-password --region $AWS_REGION | \
  docker login --username AWS --password-stdin \
  $(aws sts get-caller-identity --query Account --output text).dkr.ecr.$AWS_REGION.amazonaws.com

Pods Stuck in Pending

kubectl get nodes  # Check node availability
kubectl describe pod <pod-name> -n insurance-claims  # Check events

MongoDB Connection Issues

kubectl get pods -n insurance-claims -l app=mongodb
kubectl logs -n insurance-claims -l app=mongodb --tail=50

Check Application Logs

kubectl logs -n insurance-claims -l app=web-interface --tail=100

🔄 Maintenance

Update Application

# Pull latest changes
git pull origin main

# Rebuild and deploy web interface
./rebuild-web-interface.sh

Update Infrastructure

cd infrastructure/terraform
terraform plan
terraform apply

Backup MongoDB

# Create backup
kubectl exec -n insurance-claims <mongodb-pod> -- \
  mongodump --out=/backup --username=admin --password=<password> --authenticationDatabase=admin

# Copy backup locally
kubectl cp insurance-claims/<mongodb-pod>:/backup ./mongodb-backup-$(date +%Y%m%d)

📊 Monitoring

CloudWatch Dashboards

  • Application Logs: /aws/eks/insurance-claims/application
  • Container Insights: Cluster-level metrics
  • Custom Metrics: Business KPIs and processing metrics

Kubernetes Monitoring

# Check pod status
kubectl get pods -n insurance-claims

# View resource usage
kubectl top pods -n insurance-claims
kubectl top nodes

# Check ingress
kubectl get ingress -n insurance-claims

🎓 Learning Resources

🤝 Contributing

Contributions welcome! Please:

  1. Fork the repository
  2. Create a feature branch
  3. Submit a pull request with clear description

📄 License

MIT License - see LICENSE file for details

🙏 Acknowledgments

  • AWS EKS Blueprints for Terraform modules
  • LangGraph team for agentic AI framework
  • Ollama for local LLM inference
  • MongoDB for flexible document storage

Built for Enterprise AI Applications
Production-ready • Scalable • Secure

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Agentic Insurance Claims Processing on Amazon EKS

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