Claims is the moment the customer finds out what their policy is worth. It is also a process full of documents — estimates, invoices, medical bills, reports and notes — that adjusters read, re-key and reconcile by hand. That makes it a natural place for AI agents, and a risky one.
Where agents help
- First notice of loss: capture the claim from any channel, check the policy is in force and propose a triage route.
- The claim file: extract amounts and dates from documents and flag inconsistencies.
- Status: spot approved claims that are not paid on time before the customer has to call again.
Where they should not decide
Coverage, settlement amounts, denials and fraud referrals have legal and conduct consequences, and the customer is entitled to an accountable decision-maker. We design claims agents to prepare those decisions with evidence and reasons, and to leave them with adjusters and investigators. On our autonomy scale, that is level 2: the agent prepares the full action, and a person approves every case.