Claims Management Agent
Streamline claims handling from notification through recovery. Automated triage, fraud detection, damage assessment coordination, and recovery optimization reduce claims processing from 15-30 days to 3-10 days.
The MGA Claims Challenge
Manual claim triage separating valid claims from denials or coverage exclusions
Fraud detection requires manual investigation across multiple data sources
Damage assessment coordination between adjusters, contractors, and carriers
Recovery coordination spanning salvage, subrogation, and third-party claims
Documentation and compliance requirements consuming administrative time
Status tracking and cedent communication through disparate systems
Extended processing timelines from weeks to months impacting cedent satisfaction
Result: MGAs spend 30-40% of claims staff time on manual administrative tasks while processing delays impact cedent relationships and recovery opportunities.
How the AI Agent Works
Claim Notification & Intake
Automatically receive and process claim notifications from multiple sources. AI extracts all claim details and immediately initiates triage and status tracking.
Intelligent Triage
Automatically evaluate coverage, policy terms, and exclusions. Route claims to appropriate handlers and flag coverage questions for underwriter review.
Fraud Detection & Validation
Analyze claim characteristics against historical patterns and fraud indicators. Identify suspicious claims with 98% accuracy, reducing fraud losses by 20-30%.
Damage Assessment & Recovery
Coordinate damage assessment and identify recovery opportunities. Track salvage, subrogation, and third-party claims automatically throughout the process.
Claims Reporting & Settlement
Generate compliant claim reports and coordinate settlement documentation. Provide real-time status to cedents and automatically manage payment processing.
Business Impact
70% Faster Processing
Claims processed in days instead of weeks
→ Improve cedent satisfaction and retention
15-20% Higher Recoveries
Proactive salvage and subrogation management
→ Direct revenue improvement on loss reserves
98% Fraud Detection
AI-powered anomaly detection and validation
→ Prevent 20-30% of fraud losses
30% Staff Time Reduction
Automated administrative tasks and coordination
→ Redeploy claims staff to high-value work
Regulatory Compliance
Automatic compliance with claim handling rules
→ Zero compliance violations or penalties
$250K-400K Annual Savings
Per MGA from efficiency and fraud prevention
→ Direct bottom-line improvement
Seamless Integration
The Claims Agent integrates with your claims management and financial systems.
Data Sources
- Claims management systems (ClaimCenter, Guidewire, Snapsheet)
- Email and document management systems
- Carrier claim portals and APIs
- Third-party adjuster coordination systems
Output Systems
- Claims reserving and accounting systems
- Fraud prevention and compliance platforms
- Cedent reporting and communication portals
- Recovery tracking and analytics dashboards
ROI & Implementation Timeline
Integration and configuration
ROI positive from operational savings
Per MGA from efficiency and fraud prevention
Ready to Speed Up Claims Handling?
See how the Claims Agent can transform your MGA operations.
Schedule Demo