Transforming Claims Processing with Agentic AI

Our client is dedicated to anticipating future needs and delivering an exceptional insurance experience that customers rave about. By rapidly adopting the latest technology and continuously refining their claims process, they ensure an extraordinary customer journey that stands out in the industry.

Partnering with us to integrate Agentic AI into their claims process will revolutionise the customer experience, making it simpler, smarter, and more efficient. Our innovative proof of concept (POC) promised a seamless, customer-centric experience with unmatched speed and efficiency, ensuring claims are processed and paid out faster than ever before.

Our goal was to showcase how an AI Co-worker could automate and resolve issues in their claims process, eliminating backlogs and lengthy processing times. By reducing claim processing time, enhancing accuracy and quality, and cutting costs and waste, we aimed to streamline the entire process. The POC was divided into two phases:

Phase One: Demonstrate how an AI Co-worker can automate, accelerate, and improve the claims process using sample data. This resulted in a rapid POC without needing connection to customer systems and data.

Phase Two: Building on the Phase One POC, connect to the client’s systems and data to demonstrate integration with their technology environment.

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The key objectives included:

• Automating Claims Manager tasks: Identify missing details, provide billing and policy previews, create case summaries, and generate documents for customer communication.
• Live claim status dashboard: Offer real-time updates and a prioritised task list.
• Reduce manual effort: Enhance efficiency and improve data accuracy.
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Approach

Working closely with the client, we developed a project brief outlining the timeframe and prioritised list of current issues within their claims process to be addressed.

• Collaborated with client-assigned Subject Matter Experts to recreate an accurate replica data set with all relevant fields.
• Used Agentic AI to obtain required data from multiple data sets.
• Employed Large Language Model (LLM) AI to interpret claim descriptions and provide processing recommendations.
• Developed custom UI components and a branded portal for claims information.
• Created a Dashboard/Policy claim card to consolidate key claim information into an easy-to-use interface.
• Provide a curated path by the AI Co-worker for the Claims Manager, guiding their next actions with precision to ensure accuracy and compliance with business processes.

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The Outcome

Within a very tight timeframe, Sysdoc successfully demonstrated that Agentic AI met the client’s success criteria. This was achieved by creating an easy-to-use branded interface that guided the Claims Manager through the claims process in line with the client’s business process and policies.

The user interface was intuitively designed, allowing users to enter questions or prompts in a conversational format or select predetermined prompts to obtain the necessary information. The client was impressed with the interface's look, feel, and user experience, expressing interest and excitement about its possibilities.

The dashboard displayed the prioritised claims, making it easy for the user to select the card they wished to review. These cards were clear and concise, and provided a next action option.

Benefits of the Solution:

• Automatic prioritisation of claims
• Reduced processing time, enhancing the ability to meet claim completion commitments
• Fewer screens to navigate for the claim manager
• Reduced cognitive load
• All information in one place
• No searching required
• Minimal training needed
• Consistent communications internally and externally (using the same template).

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The presentation showcased Sysdoc's technical capability with Agentic AI and generated genuine enthusiasm among the client's team for what is possible with AI Co-workers. The benefits of integrating Agentic AI to reshape their claims process, along with potential applications in other business areas, sparked significant interest and excitement. The process was quick and efficient, delivering outstanding results within budget and time constraints.