The problem
Claims were assessed by hand. Policyholders waited days for a decision while adjusters carried heavy, repetitive caseloads where small errors were easy to make.
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In productionMargin + customer experience
AI Agent for Insurance Claim Settlements
Health and medical insurer
Document-grounded payout recommendations, handed straight to the adjuster.
Outcome
~70% lower handling time
Average claim handling went from 10 minutes to 3. Work that once took days can now close in minutes.
What we built
- A claims engine that accepts the policy, doctor summaries, invoices, and supporting paperwork.
- A workflow that runs the claim through the insurer own claims-processing procedure.
- A recommendation layer that returns the payout owed, ready for adjuster review.
Business impact
Faster settlements and more consistent payout recommendations reduce cost per claim while improving customer satisfaction and the insurer reputation for fast handling.
Why it stands up
The agent reads the same material a human adjuster receives, follows the insurer procedure, and returns the payout recommendation.
Live in production
Accuracy controls on every payout recommendation
Grounded strictly in submitted policy terms
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