PR-01Active
Conversational Agent
Conducts claim intake interview, asks discovery questions, collects supporting information
SHEET 01Use CaseInsurance Claims Processing
Automate insurance claims intake, assessment, and approval workflows
Intake claims across voice, chat, and document upload. Extract loss details, verify policy coverage, assess damage estimates, and route to adjusters — with fraud signal detection.
68%of claims auto-approved without adjudicator review
2.1 daysaverage claim cycle time (vs. 5-7 days)
8.6%reduction in claim denial rate
1.8 FTEequivalent adjudicator capacity freed per 10K claims
SHEET 02The ChallengePROBLEM
The claims processing challenge
Insurance companies receive thousands of claims daily via forms, email, phone, and portals. Claim intake data is incomplete or inconsistent. Adjudicators manually review files, verify coverage, apply underwriting rules, and compute benefits—a slow, error-prone process. Denials are often appealed due to perceived unfairness. Fraud detection relies on manual flags and historical patterns. Policyholders expect instant decisions but typically wait 5-7 business days.
SHEET 03The SolutionASSEMBLY
How assistents automates claims processing
assistents claims agent collects claim information from policyholders via voice, chat, or online form, asking discovery questions to understand the loss or service request. The agent verifies coverage in real time, applies policy terms and underwriting rules, and computes benefits automatically. Document AI extracts supporting documents (medical records, repair estimates, police reports). Fraud risk is scored. Low-risk claims are auto-approved; complex cases escalate with full context. Real-time communication keeps claimants informed.
PR-02Active
Document AI
Analyzes supporting documents (medical, repair estimates, receipts), extracts claim-relevant data
PR-03Active
Workflow Agent
Verifies coverage, applies underwriting rules, computes benefits, flags for escalation or approval
SHEET 04How It WorksPIPELINE
How claims processing agents work
- STEP 01Submit claim
Claimant initiates claim via portal, phone, or form. Agent greets and begins intake interview.
- STEP 02Collect information
Agent asks about loss/service, dates, involved parties, and damage or service details.
- STEP 03Request documents
Agent requests supporting documents (medical records, repair estimates, receipts). Tracks submission.
- STEP 04Verify coverage & rules
Agent confirms policy is active, applies terms and exclusions, checks for coverage gaps.
- STEP 05Approve or escalate
Low-risk claims are auto-approved; claimant receives check or authorization. Complex claims escalate.
5 steps deploy to production in weeks
SHEET 05Measurable OutcomesMEASURED
Measurable claims processing outcomes
68%of claims auto-approved without adjudicator review
2.1 daysaverage claim cycle time (vs. 5-7 days)
8.6%reduction in claim denial rate
1.8 FTEequivalent adjudicator capacity freed per 10K claims
SHEET 08Sign-offREADY
Ready to see this in action?
Schedule a personalized demo to see how assistents’s AI agents can solve this challenge for your organization.
- Stage
- Discovery to production · 4 weeks
- Deployment
- Cloud · On-premise · Hybrid
- Governance
- Audit trail on every action
- Sheet
- 8 of 8 · Use Case