In the insurance industry, claims adjudication is a core process that directly impacts customer satisfaction, operational efficiency, and financial performance. Yet, for many insurers, this process remains riddled with manual tasks, paper-based documentation, and delayed decisions.

That’s where AI-based workflow automation comes in transforming traditional claims processing into a streamlined, intelligent, and proactive operation.

At Amantra, we’re helping insurers move beyond outdated systems by introducing AI-powered workflows that understand, learn, and optimize every step of the adjudication process.

Why Traditional Claims Adjudication Is Holding You Back

Manual or semi-automated adjudication typically involves:

• Time-consuming data entry and form validation
• Rule-based systems that can’t handle complex scenarios
• Human error in interpretation of policy conditions
• Slow fraud detection and escalation
• Disconnected teams and lack of workflow visibility

These inefficiencies not only slow down the claims lifecycle but also affect customer trust and regulatory compliance.

What AI-Based Workflow Automation Does Differently

AI brings speed, intelligence, and context-awareness to claims adjudication. Here’s how:

1. Automated Claims IntakeAI agents automatically extract, validate, and classify claims data from forms, emails, scanned documents, and portals using Intelligent Document Processing (IDP) and Natural Language Understanding (NLU).
2. Smart Triage & RoutingBased on claim type, amount, policy terms, and historical patterns, AI determines the optimal adjudication path routing simple claims for straight-through processing and complex ones for expert review.
3. Real-Time Eligibility ChecksAI cross-references the claim with policy data, past claims, and third-party sources to instantly validate eligibility reducing manual lookup time and decision delays.
4. Intelligent Decision SupportAI provides contextual recommendations to adjudicators by analyzing policy documents, previous outcomes, and fraud indicators making the decision process faster and more accurate.
5. Automated Communications & UpdatesPolicyholders are automatically notified at key stages of the claims process via email, SMS, or chatbot enhancing transparency and engagement.

Amantra’s AI-Driven Claims Automation Capabilities

At Amantra, our claims adjudication framework offers:

• • End-to-end automation for first notice of loss (FNOL) to settlement
  • Agentic AI workflows that adapt to claim complexity and risk
  • Dynamic rules engine to reflect regulatory and policy changes
  • Built-in fraud detection using anomaly detection and ML scoring
  • Audit-ready logs for every decision and action

From Cost Center to Experience Center

By embedding AI across the adjudication lifecycle, insurers can shift from a reactive claims operation to a proactive customer experience engine. The result? Faster settlements, smarter decisions, and a competitive edge in a fast-evolving industry.

Ready to Revolutionize Your Claims Process?

Let Amamtra help you accelerate claims adjudication with intelligent, adaptive, and compliant AI workflows.

Book a Demo | Talk to Our Insurance Automation Experts