Automated Claims Processing Agent
End-to-end autonomous claims processing agent that verifies details, detects fraud, and initiates payouts in seconds.
Executive Summary
An insurance company deployed an AI claims agent that processes simple claims end-to-end in as little as 2 seconds. The system handles 45% of all claims autonomously, with computer vision for damage assessment and real-time fraud detection.
Background & Context
Insurance claims processing is one of the most labor-intensive operations in financial services. The average auto claim takes 10-15 days to settle, requiring multiple handoffs between customers, agents, and adjusters. This delay frustrates customers at their most vulnerable moments and drives up operational costs. Meanwhile, fraud continues to rise, with estimates suggesting 10% of claims contain some element of fraud. The industry needs a way to accelerate legitimate claims while catching bad actors.
The Challenge
Traditional claim processing is labor-intensive, often taking days or weeks of back-and-forth between customers, agents, and adjusters. This results in high administrative costs and customer frustration.
Simple claims were clogging the system, preventing adjusters from focusing on complex cases that required human judgment.
Our Approach
We built an end-to-end claims agent that handles the entire process autonomously for straightforward cases. The system uses computer vision to assess damage from photos, NLP to extract claim details, and fraud detection to identify suspicious patterns. Claims that pass all checks are settled instantly; complex cases are routed to human adjusters with AI-prepared summaries.
Solution Workflow
The diagram below shows how claims flow through our automated processing system, from submission through damage assessment, fraud detection, and instant payout.
The Solution
An AI-powered claims bot that guides users through filing a claim and autonomously processes it end-to-end.
- Conversational AI Agent: Converses naturally with customers to gather claim info via chat interface.
- Computer Vision Analysis: Analyzes photo evidence to verify damage and policy details automatically.
- Fraud Detection Engine: Runs real-time algorithms to detect anomalies and flag complex cases for human review.
Key Technologies
Technical Architecture
Computer Vision
Advanced models to assess damage from user-uploaded photos.
Decision Engine
Rule-based and ML hybrid system to approve legitimate claims instantly.
Instant Payout
Integration with payment rails to settle claims immediately upon approval.
The Impact
The system now handles nearly half of all claims submitted without human intervention.
Speed & Efficiency
- •Settles legitimate claims in as little as 2 seconds.
- •Drastically cut processing time from days to minutes.
Customer & Business
- •High customer satisfaction (NPS) due to quick resolutions.
- •Reduced operational costs by automating routine cases.
Record Breaking Speed
Settling a claim in 2 seconds sets a new world record for the industry.
Key Takeaway
Automating claims has allowed the company to drastically cut processing time, reduce operational costs, and achieve high customer satisfaction.
Streamline your claims processing with AI.
Discover how our Automated Claims Agent can improve efficiency and customer satisfaction.