According to Experian's State of Claims 2025 report, more than half of insurers (54%) say claim errors are increasing, and nearly seven in ten (68%) find submitting clean claims more challenging than they did a year ago. As costs rise and customer expectations grow, insurers are realizing that traditional automation – while once sufficient – can no longer keep pace with the complexity of modern claims.
We are now entering the era of agentic AI: intelligent, goal-driven systems that work collaboratively to interpret data, make decisions, and adapt in changing conditions. When combined with intelligent orchestration, agentic AI allows insurers to accelerate claims resolution, improve accuracy, and deliver transparency at every step of the process.
Digital Insurance Workflows: Accelerating Resolution
Claims handling has long been one of the most resource-intensive areas of insurance operations. Agentic AI changes that dynamic. Instead of relying on static workflows or human-led review queues, autonomous agents can continuously gather and assess data from multiple sources—emails, repair estimates, photos, and videos—and validate coverage in real time.
An AI agent can instantly classify the complexity and exposure of a claim, cross-reference it with policy details, and even calculate settlement recommendations based on prior decisions. Straightforward claims can be resolved automatically within hours, while complex or high-risk cases are routed directly to human adjusters with a full, auditable summary of every AI-driven action.
This creates a system where human expertise is amplified, not replaced—allowing adjusters to focus their time on empathy, judgment, and nuanced decision-making.
The Power of Automating Insurance Claims
The claims process is pivotal to the customer journey. Bottlenecks lead to frustration, slow resolutions, and lost trust. Insurers that leverage agentic AI demonstrate operational excellence while simplifying tracking, providing visibility, and improving efficiency.
Contrary to concerns about AI replacing jobs, this is a collaborative model: AI handles repetitive or time-sensitive tasks, and humans focus on strategic decisions and customer engagement. This collaboration benefits both employees and clients.
Accuracy Isn't Optional
Accuracy is mandatory in insurance. Errors or inconsistencies undermine both compliance and customer confidence. Agentic AI enforces consistent, compliant processing while minimizing human error and leakage.
Fraud detection is another area where AI excels. By cross-referencing claims with historical data, public records, and behavioral patterns, agentic AI identifies anomalies before payouts are made. These systems don't just detect fraud—they prevent it, learning from emerging patterns and adapting continuously.
Keeping Teams Involved
Human adjusters remain central to automated workflows. Human-in-the-loop strategies empower staff to validate complex claims, oversee governance, and ensure customer satisfaction.
Autonomous agents automatically route large losses, liability disputes, or high-risk flags to the human team with a complete, aggregated summary of every AI-driven action. Every step is logged and auditable, giving supervisors and regulators full transparency while ensuring confidence in autonomous workflows.
Being Present And Forward-Thinking
When adopted strategically, agentic AI transforms claims from a cost center into a competitive differentiator. Insurers gain speed, scalability, and compliance—while delivering higher customer satisfaction.
The next step for leaders is identifying high-impact, low-complexity workflows to pilot and refine. The insurers who take that step now will define what "intelligent insurance" means for the industry over the next decade.
