Our client is a leading insurance provider managing high volumes of claims across multiple regions. Timely and accurate claim settlement is critical for customer satisfaction, regulatory compliance, and operational efficiency. However, the growing scale of operations brought significant challenges. Claims were often verified manually, leading to delays, higher error rates, and inconsistent decision-making. Customers experienced longer wait times for settlements, which impacted trust and brand reputation. The client needed a smarter, automated approach to claims handling that could reduce manual intervention, improve turnaround time, and enhance overall customer experience while maintaining compliance.

Challenge: Manual Verification Slowed Settlements

The insurer faced significant challenges with its traditional, human-driven claim verification process:

• Delays in Processing: Manual checks across multiple systems extended settlement timelines, frustrating both customers and internal teams.
• High Risk of Errors: Human errors in data entry, cross-verification, and documentation frequently led to rework, increasing costs and compliance risks.
• Customer Dissatisfaction: Slow payouts and lack of real-time updates diminished customer confidence and brand reputation.
• Resource Drain: Skilled staff were spending excessive time on repetitive verification tasks instead of focusing on higher-value activities such as fraud detection or customer engagement.
• Scalability Issues: As claim volumes grew with business expansion, manual processes could not keep pace, creating operational backlogs and missed service-level agreements (SLAs).

 

Solution: Agentic AI for Fast, Accurate Claim Processing

Amantra deployed Agentic AI to transform the insurer’s claims management process, introducing intelligence, autonomy, and scalability. Unlike traditional rule-based bots or manual workflows, the system functions as an autonomous agent capable of understanding, verifying, and making decisions in real time.

Key Solution Components:

• Automated Document Extraction: AI agents extract critical data from claim forms, invoices, and supporting documents, eliminating manual entry.

• Intelligent Verification: Cross-checks against policies and business rules minimize human error and ensure accuracy.

• Exception Handling & Risk Assessment: Only complex or high-risk claims are flagged for human review, while standard claims are processed automatically.

• Real-Time Monitoring & Analytics: Dashboards track claim progress, highlight bottlenecks, and provide actionable insights for operations and management.

• Scalable Automation: The system adapts to increasing claim volumes without requiring additional manual effort, supporting business growth seamlessly.

This deployment allowed the insurer to accelerate claim processing, reduce errors, improve customer satisfaction, and scale operations efficiently, turning claims management into a proactive and autonomous function.

Results: Faster, Accurate, and Customer-Centric Claims

• Claim processing time reduced by 60–70%
• Significant reduction in errors, improving accuracy and compliance
• Enhanced customer satisfaction with timely claim payouts
• Operational efficiency, allowing staff to focus on complex cases
• Future-ready infrastructure, capable of scaling with claim volumes

Key Takeaway: Agentic AI Turns Claims into a Competitive Advantage

With Amantra Agentic AI, insurers can automate claim verification, accelerate settlements, reduce errors, and enhance customer experience, transforming claims processing from a slow, manual task into a strategic operational asset. By eliminating repetitive checks and ensuring accuracy across systems, claims that once took days can now be verified within hours or even minutes.