State model
Append-only case events feed a current-state projection. Evidence rows keep source, observation time, validity, correction history and narrative usage.
An indemnity claim depends on mandate, notification, collection history, merchant evidence and exception rules that differ by event type.
A case builder reconstructs mandate and collection state, applies deterministic eligibility rules and prepares the evidence required for payment or challenge.
Organisations, systems and operating conditions are intentionally anonymised and recomposed. The design demonstrates engineering and banking-domain reasoning; it does not represent a named client estate, vendor product or measured production result.
A shared authority core coordinates independently owned capability cells, domain systems and operating evidence.
Permitted workThe AI layer may diagnose, prepare and coordinate. Core servicing effects, remediation and complaint outcomes remain policy-controlled actions.
Consistency ruleKeep one durable case state and explicit custodian while source effects reconcile asynchronously.
Hard boundaryThe model is not a system of record, identity provider, policy authority or proof that an external effect occurred.
An alert or case requires evidence fan-out, deterministic triage, residual model reasoning and a defensible human disposition.
Eligibility and time limits are rule-calculated; models only extract and explain.
A deterministic outer workflow contains model-led work inside typed, observable calls. Dashed messages remain proposals until policy or a human grants authority.
Append-only case events feed a current-state projection. Evidence rows keep source, observation time, validity, correction history and narrative usage.
Use asynchronous ingestion and bounded parallel reads. Slow providers have independent timeout and circuit-breaker policy so one source cannot exhaust the case tier.
Pin policy and evidence versions at case open. Later corrections append and may trigger reassessment; they do not rewrite the historic basis silently.
These roles are deliberately vendor-neutral. Each can be independently owned, versioned and replaced.
Evaluates identity, purpose, capability, amount, risk tier and policy version; returns allow, deny, step-up or human-review with reasons.
Appends request, versions, policy result, model proposal, approval, action receipt, readback, correction and custody events under one correlation key.
Builds time-qualified projections from source events and reconciliations without becoming the legal system of record.
Presents claims beside evidence, alternatives, uncertainty, missing information, permitted actions and current custody.
Durable records carry provenance, authority, effect and custody without turning a transcript into an uncontrolled memory store.
Keep one durable case state and explicit custodian while source effects reconcile asynchronously.
The selected design is not universally superior. It is the safer fit for this boundary and failure cost.
Compile stable decision logic and retain retrieval for explanation and residual ambiguity.
Ask a model to interpret the source document for every request.
Cost acceptedRule compilation needs controlled change, but creates repeatable decisions, regression tests and clear exceptions.
Use append-only events plus a rebuildable current-state projection.
Overwrite the case row with its latest status.
Cost acceptedReplay and storage are more complex, but point-in-time reconstruction and correction lineage remain possible.
Use event-fed projections for scale and direct readback for consequential effects.
Fan out to all systems of record for every interaction.
Cost acceptedRead models introduce lag and reconciliation work, but reduce source load and make cross-system views feasible.
Keep people at irreversible, ambiguous and policy-exception points; sample lower-risk automated outcomes independently.
Require the same manual approval at every step.
Cost acceptedRisk-tiering reduces review load but needs calibrated thresholds, sampling and immediate withdrawal of authority when drift appears.
Retries are bounded by knowledge of business effect; unknown outcome remains visible, owned and independently reconciled.
Actual thresholds belong to accountable service owners. The design exposes the equations and observables that those owners must baseline.
peak_enrichment_qps = peak_case_rate x sources_per_casereview_hours = residual_cases / investigator_throughputevidence_storage = cases x evidence_rows x retention_windowTransfer only case-relevant evidence between teams and retain communication history according to the case class.
A design is production-ready only when teams can prove what happened, recover it and change it safely.
partial completion and retry test
timer and deadline preservation
case handoff acceptance
customer communication readback
Mandate lineage, notices, transaction history, rule trace, exceptions and final disposition.
Operations confirms eligibility and any exception treatment.
Use shadow decisions and blind samples before allowing deterministic closes. Keep agent-touched cases under human disposition until operating evidence supports narrower review.
Servicing operations, product, complaints, legal and records owners set the operating controls.