What is Agent Workforce?

Agent Workforce is a suite of specialised AI claims agents created by Digital Workforce Services Plc, empowered to automate the entire insurance claims journey – from First Notification of Loss (FNOL) to final settlement – working alongside your i existing systems.

Instead of one monolithic “AI system,” Agent Workforce gives you a coordinated digital workforce of task-specific AI agents that read documents, interpret policies, detect fraud, make adjudication decisions, and trigger payments . A master agent orchestrates the complete claim journey with humans staying in control of edge cases and judgement calls.

In short: it’s how an insurer “recruits” its first AI knowledge workers to scrutinise every claim as if it were the only one that day – without hiring hundreds of new people.

Why insurers need an Agent Workforce now

Across general insurance, especially in health/medical and personal lines, claims operations are hitting the same limits:

• Highly skilled staff stuck in manual work – managing increasing volumes of claims documentation and data, eading broker submissions, medical reports, service invoices, and rekeying data into core systems.
• Fragmented, legacy processes – legacy systems, off system spreadsheets, shared inboxes, and multiple policy/claims systems that don’t talk to each other.
• Rising expectations for speed and transparency – customers demand more – comparing claims to same-day deliveries and instant banking.
• Tougher regulation and scrutiny – ever increasing regulation and stricter governance frameworks adding admin burden, from Consumer Duty-style rules to data privacy and model governance, particularly in the UK and EU.

Traditional automation (RPA, rules engines, chatbots) has delivered local optimisation. But with today’s volumes, complexity, and compliance demands, adding more macros or headcount doesn’t fix the structural problem: knowledge work is still fundamentally manual and limited by finite SME resources

Agent Workforce is designed to change that – safely – by bringing agentic AI into production claims processes in a controlled, auditable way.

Formal definition: What is Agent Workforce?

From a business and technical perspective, Agent Workforce is:

A portfolio of enterprise-grade AI claims agents, operated as a managed service by Digital Workforce, that plug into existing insurance systems to autonomously execute well-defined tasks across the claims lifecycle.

Key characteristics:

• Insurance-specific: Agents are pre trained and configured specifically for general insurance claims – with an initial focus on medical and health-related claims, and a roadmap across other GI lines.
• Task-specialised: Each agent has a clear role – such as FNOL, data capture, unstructured data inference, policy interrogation, fraud intelligence, claim adjudication or settlement.
• Workflow-aware: Agents don’t just answer questions; they follow a runbook, orchestrate steps to achieve the desired outcome, call APIs and update core systems.
• Enterprise-ready: Built on Microsoft Azure and Microsoft Foundry-based orchestration, with logging, audit trails, access control and integration patterns aligned to large insurers’ risk and compliance requirements.
• Human-in-the-loop by design: High-risk or ambiguous cases are escalated to human handlers; thresholds and guardrails are configurable per client.

This is not a generic chatbot, copilot or an off-the-shelf LLM bolted onto your claims system. It is a production-grade, agentic AI claims workforce that takes responsibility for clearly defined tasks end-to-end. Working alongside your existing teams to transform tranditional workflows.

Meet the Agent Workforce: the AI claims team

Agent Workforce is structured as a team of named agents, each responsible for a specific part of the claims journey.

Each agent can be deployed independently to work alongside your teams or as part of a coordinated Agent Workforce that manages the end-to-end claims journey.

How Agent Workforce fits into your architecture

Agent Workforce is designed to plug into, not replace, your core systems:

• Integrates with existing PAS, claims management, document management and CRM platforms via APIs and standard interfaces.
• Runs on Microsoft Azure, using Microsoft Foundry capabilities for agent coordination, security and observability.
• Operates within your existing network, data residency and security constraints.

From a governance perspective:

• Every action taken by an agent is logged, traceable and reviewable, supporting internal audit and external regulators.
• Human decision-makers retain veto power; agents follow explicit Natural Language Instructions/runbooks owned by your business SMEs.
• You can start with low-risk, high-volume tasks (for example medical claims FNOL) and expand as confidence grows, rather than committing to a big-bang transformation.

Business outcomes: what insurers get from an Agent Workforce

Insurers deploying AI agents in production are already reporting step-change improvements, not just marginal gains.

Typical outcomes include:

• Faster claims cycle times
  FNOL to decision in minutes instead of hours or days i
  Real-time handling of volume spikes without extra headcount. No seasonality or backlog concerns. Infinitely scalable.
• Lower cost per claim
  Minimum 20–30% reductions in loss-adjustment expenses where AI agents take over repetitive, document-heavy tasks.
  Better use of skilled adjusters to focus on complex, empathic work instead of admin.
• Improved loss ratios and leakage control
  More consistent coverage checks and benefit calculations.
  Earlier detection of fraud, claims wastage and subrogation opportunities, even in STP flows.
• Better customer outcomes
  Faster, clearer decisions that align with Consumer Duty expectations for fair value and communication.
  Reduced frustration from repeated questions, reworks and document requests.
• Stronger compliance and risk control
  Built-in audit trails, versioning and explainability for AI-assisted decisions.
  Guardrails that prevent agents from acting beyond their defined scope.

Put simply: Agent Workforce lets you decouple outcomes from headcount – scaling claims performance without scaling the payroll at the same rate.

How Agent Workforce differs from RPA, chatbots and pre-built AI models

Many insurers are already experimenting with GenAI, off-the-shelf models and chat-based tools. The experience is often the same: interesting demos, modest productivity gains, but no real operating-model change.

Agent Workforce differs in three important ways:

• From “assistant” to “owner of the task”
  Pre-built models answer questions or summarise documents.
  Agents own a task end-to-end: they plan steps to achieve an outcome, call systems, make decisions within defined rules, and close the loop.
• From generic to insurance-native
  Generic LLMs are trained on broad, generic internet data and often misinterpret policy language or outdated rules.
  Agent Workforce is tuned and governed around insurance-specific workflows, with ongoing in-context learning rather than one-off fine-tuning.
• From local scripts to enterprise infrastructure
  RPA bots and macros sit on top of legacy processes, often fragile, hard coded and difficult to scale.
  Agent Workforce is delivered on an enterprise AI platform with observability, security, and orchestration built-in, making it realistic to run hundreds of agents safely across the organisation.

Typical use cases for Agent Workforce

Agent Workforce is already being applied across:

• Medical and health insurance claims
  High volume, document-heavy, complex benefits and rich in unstructured medical data – ideal for Nora, Petra, Anders and Sera to handle together.
• General insurance (motor, property, travel and more)
  FNOL intake, triage, coverage checks, interfacing with external service vendors, fraud detection and settlement for mid-complexity claims.
• TPAs and shared service centres
  Multi-carrier environments where standardising and scaling processes is difficult with purely human teams. Agents are location agnostic and completely scalable to cater for claim volume changes.

Across all of these, the pattern is the same: start with a clearly defined slice of the claims journey, deploy a small team of AI agents alongside your people, validate outcomes and then scale.

Is Agent Workforce safe and compliant for regulated markets?

Insurance is one of the most regulated, data-sensitive industries in the world. Any viable AI solution needs to respect that reality.

Agent Workforce is designed for regulated environments from day one:

• Data handling follows strict security and privacy controls, aligned to regional regulations (e.g. FCA expectations, EU data protection).
• Every AI-assisted decision can be traced back to its inputs, versioned model and decision path.
• Agents operate inside a zero-trust mindset with strong access control and continuous monitoring, rather than “deploy and hope”.
• Human supervisors remain accountable; the technology exists to help them demonstrate compliance more consistently at scale.

For insurers, brokers, and TPAs, that means you can adopt AI agents without compromising on the standards regulators and customers rightly expect.

FAQ: quick answers about Agent Workforce

Is Agent Workforce a product or a concept?

Both – but in this context, Agent Workforce refers to the named suite of AI claims agents developed and operated by Digital Workforce Services Plc, delivered as a managed service to insurers and TPAs. The Agent capabilities have been designed to address common pain points in traditional risk management workflows.

Do we need to replace our core systems?

No. Agent Workforce is system agnostic and integrates with your current PAS, claims and document systems and is explicitly designed to work with existing legacy investments rather than rip-and-replace.

How quickly can we see value?

Most insurers start with a narrow, high-volume use case (for example medical FNOL or standard benefit claims) and see measurable improvements in weeks to months, not years, because the agents are pre-configured for insurance workflows.

Will AI agents replace our people?

Agent Workforce is built to elevate claims teams, not erase them – taking over repetitive, error-prone work so your specialists can focus on complex judgement, customer conversations and continuous improvement.