Insurance services firm · Insurance / Back office · 7 weeks
Claims processed 40% faster with a human-gated agent
An agent assembles each claim file, checks it against policy rules, and queues a recommended decision. Humans approve; nothing pays out on its own.
40%
faster claims cycle
intake to decision
−22%
rework rate
fewer missing-doc loops
100%
decisions human-approved
full audit trail
The challenge
Each claim meant assembling documents from three systems, checking them against policy rules, and chasing whatever was missing. Adjusters spent more time collating than deciding, and every missing document added a full day of back-and-forth.
What we shipped
An agent that builds the claim file the moment a claim opens: pulls documents from the policy system, the document store, and email, runs completeness checks against the policy's rule set, and requests missing items from the claimant automatically — with every request logged.
When the file is complete, the agent drafts a recommended decision with the relevant policy clauses cited. An adjuster reviews and approves every single one. The agent never moves money; it moves paperwork.
The outcome
The intake-to-decision cycle shortened by 40%, rework loops dropped by a fifth, and audit prep went from a scramble to a query — every step of every claim has a trace.
Compliance signed off because they could finally see everything. The speed was almost a side effect. — VP of Claims Operations
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