AI for Insurance Operations
One agent architecture for the whole operation
Claims is the core. Around it, the same architecture runs everything an insurance operation handles day to day: assistance, coordination, engagement, network and finance. Agents prepare and recommend, your rules compute, your team decides and sees everything.
The operations map
Every queue, one architecture
One front door classifies everything that arrives. Five queues process it, each with its own agent. Two shared capabilities and the platform cut across all of them.
Every submission, every channel: email, portal, phone, paper. Captured, structured and routed to the right queue.
Reimbursement end to end: intake, evidence and integrity checks, fraud screening, recommended decision, payment-ready file.
Medical and non-medical assistance requests: triage, provider search and assignment.
Pre-certifications and authorizations: coverage and copay checks, letters, clinical routing.
General inquiries and sales conversations: suggested responses, approved replies.
Provider tariffs kept clean, payment operations consolidated across clients and currencies.
Every queue, every state change: the customer always knows where their case is.
Reviews up to 100% of decisions across queues and turns them into business insight: price outliers, provider patterns, portfolio trends.
Available today
The core is Claims47
The Claims47 agent, with its four capabilities (intake and triage, evidence, communication, insights), is in production, part of +500,000 claims & insurance processes run per year. Everything on this page extends that core: one agent per operation domain, same platform, same rules, same audit trail.
Extension agents
How far the same architecture goes
Extension agents are delivered in waves inside a live TPA transformation, co-built with a client in production. They are not sold standalone: they extend the Claims47 core, on the same platform, governed by the same rules.
Assistance AI Agent
Assistance requests end to end; a medical team involved only where clinically needed.
Coordination AI Agent
Non-urgent authorizations recommended for automatic approval where your rules allow.
Engagement AI Agent
Inquiries and sales: the simple resolved by AI, the complex kept with humans.
Network AI Agent
The provider network's commercial side, kept clean and current.
Finance AI Agent
Payment operations across clients, providers and currencies.
In production
From claims core to full operation
A US-based travel-medical TPA started with the claims core: intake in any language and currency, validation, fraud screening and payment-ready decisions, with Claims47 acting as the system of record. Today the same agent architecture is being extended across its whole operation in successive waves: assistance, pre-certification, member communication and insights, with humans in the loop on every exception.
Reference available under NDA.
Who it's for
Built for operations that carry the volume
TPAs
Volume grows faster than headcount can. Agents absorb the routine work per queue, and every client keeps its own rules and visibility.
Assistance companies
24/7, multichannel, multilingual. Triage, provider assignment and member communication stop depending on who picks up the phone.
Insurers with delegated operations
Visibility and control over the whole chain: every decision logged, every SLA measured, every rule yours.
Let's map your operation
A 30-minute working session: we walk your operation queue by queue and show where agents fit first. No demo required, no commitment.