AI for every step of the Medical Claims Journey
At Agent Workforce, Clara with a team of AI-powered claims agents are helping insurers like you tackle key claims challenges - think long turnaround times, leakage and fraud, inconsistent decision making, and raising cost per claim - all while elevating customer experience.
Eliminate Fraud
Reduce Costs
Speed up Decisions
Precision-Built AI Agents:
Built specifically for claims operations, each agent is trained for a specialized task – First Notice of Loss, triage, data capture, assessment, fraud detection, unstructured data processing, and settlement. Each Agent can operate independently or be deployed as a team to manage entire claims end-to-end. The result? Faster payouts, better fraud detection, and happier policyholders.
0%
faster FNOL-to-settlement
0%
fewer manual touches
0x
ROI in 90 days
Highlights & Benefits
Faster and More Accurate Decisions:
Agents process claims in real time, scaling effortlessly during surges, no additional headcount is required.
Lower Operational Costs:
By automating tasks from repetitive data capture to complex adjudication, you cut overhead for data entry and manual claim processing, directly reducing per-claim expenses.
Reduced Manual Workload:
Intelligent Agents handle work, freeing adjusters to focus on high-value tasks like customer engagement.
Happier Customers:
Faster claim approvals and fewer errors create a smoother experience, improving satisfaction and fostering loyalty.
Seamless Integration:
Our AI Agents plug into existing workflows and systems through secure APIs, no heavy IT overhaul needed.
Guaranteed ROI:
We offer a transparent implementation model with measurable results, if our Agents don’t hit agreed targets, you don’t pay.
AI Colleagues for Every Step of the Claims Journey
Our approach with the team of AI-powered Agents replaces piecemeal automation with fully autonomous AI Agents assigned to well-defined roles, just like human team members. They communicate in natural language and act like any colleague, but they never come physically to work as they work always remote.
How They Work Together
Each agent excels in a specific function - like data capture, fraud detection, or settlement. By working in tandem, they form a virtual claims team that can handle entire claim journeys without bottlenecks. Whether it’s a straightforward private GP expense claim or a complex medical claim, Clara and its team share data seamlessly, ensuring quick, accurate outcomes for insurers and their policyholders.
The AI Team Transforming Every Stage of Your Claims Process
Dalia
Data Capture Agent
Automates the extraction of key data from FNOL documents (e.g. images, reports, and even voice communications) catching missing or inconsistent details before passing the claim forward.
Clara
Coverage & STP Assessment Agent
The master Agent that coordinates the actions as well as integrates with your CMS and PAS to, verify completeness and checks coverage rules qualifying claims to STP or manual processing.
Nora
Unstructured Data Inference
The helper Agent for Clara with the job to transform handwritten notes, PDFs, or free-text fields into structured data and standardized codes (e.g., clinical).
Fiona
Fraud Intelligence & Network Analysis Agent
Leverages pattern analysis to spot suspicious claims and potential subrogation opportunities right at FNOL detecting fraud early and minimizing fraud losses.
Anders
Claim Adjudication Agent
References policy details, underwriting rules, coverage limits, and prior claim history to approve or escalate claims. Anders is the co-pilot for your claims adjudication team.
Sera
Settlement & Communication Agent
Finalizes payment instructions for approved claims and crafts personalized communication to policyholders, expediting settlement and fostering transparency.