From Claim Intake to Adjudication: How Agentic AI Is Eliminating Manual Bottlenecks in Claims Processing

In insurance, claims are where promises are kept or broken. Yet for many insurers, this vital function remains painfully outdated. Slow intake, fragmented documentation, misrouted cases, and manual review cycles continue to define the claims experience. The result? Delays, errors, spiraling costs, and frustrated customers. 

The numbers paint a stark picture. According to Accenture, poor claims experiences could put $170 billion in premiums at risk over the next five years. Nearly one-third of policyholders are dissatisfied with how their claims are handled, and 60% of them cite slow settlement as the reason. In the U.S., auto claims now take an average of 22.3 days to settle, with repair costs up 26% in just two years. It's no wonder 80% of policyholders who go through a poor claims process either switch insurers or plan to. 
 
But the issue isn’t just customer dissatisfaction. Behind the scenes, outdated, manual workflows bleed time and money. Industry estimates put the cost of manual rework at $25 per claim, and that’s before factoring in the risk of errors, delays, and reputational damage. Nearly 75% of dissatisfied claimants have switched or are considering switching providers. 
 
These inefficiencies have a major impact, resulting in billions in lost revenue, higher operational costs, and eroding loyalty. And insurers know it. According to a 2024 Gallagher Bassett and Triple-I industry survey: 

• 54% of insurers are now implementing digital FNOL solutions.
• 57% are investing in tech to speed up claims resolution.
• 67% of insurers use AI chatbots or virtual assistants for customer service.
• 45% use AI for claims-related tasks.
• Nearly half of insurers are rolling out AI-driven claims automation. 

 
Despite APAC now accounting for nearly 24% of the global AI market, legacy systems remain a major barrier. In fact, 41% of APAC insurers still rely on outdated infrastructure that holds back modernization. 

The Problem: Claims Are Still Manual at the Core 

Despite the growing urgency, the First Notice of Loss (FNOL) process often starts with a phone call, an email, or a paper form; each requiring a human to read, categorize, verify coverage, and manually route the case. Multiply this across thousands of claims, and the inefficiencies become overwhelming. 

• Documents go missing or arrive incomplete (NIGO).
• Claims are routed to the wrong adjudicator.
• Fraud slips through because reviews are rushed, inconsistent, or error prone. 

These aren’t just operational issues; they directly impact margins, service quality, and customer retention. 
 
The Solution: A Multi-Agent Orchestration for Claims 

Neutrinos has built and deployed a set of intelligent agents that, when working together, transform claims processing from reactive to real-time. Here’s how: 
 
1. FNOL Intake Agent: Captures loss details via contextual conversations. No more back-and-forth with call centers or missing fields. Customers file digitally, and the agent handles structured and unstructured inputs. 
 
2. Claims Triage & Routing Agent: Uses AI to classify and prioritize cases, verify documents, and route to the right adjudicator. It replaces spreadsheet queues and guesswork with intelligent, dynamic triage. 
 
3. Summarizer Agent: Reads through medical reports, policy documents, and application forms, extracting key data and generating concise summaries for faster adjudication. 

4. Coverage Validation Agent: Checks eligibility in real time using policy data, avoiding unnecessary processing of invalid claims. 

5. Fraud Detection Agent: Runs predictive anomaly detection and NLP-based pattern analysis to catch suspicious claims early, minimizing false positives and losses. 

The Impact: 50% Faster, Fully Auditable Claims 

A tier 1 life insurer in South Asia replaced an 8-person email-based claims intake team with this multi-agent setup. The result? 

• Cycle time cut in half
• Human errors eliminated
• FTEs redeployed to strategic roles
• Auditable, consistent decisioning across claims 

 
From Bottlenecks to Breakthroughs: The Future of Claims Is Here 

This isn’t about replacing people; it’s about elevating them. Let AI handle the repetitive, document-heavy tasks while claims professionals focus on complex or sensitive cases. Agentic AI doesn’t require a full core systems overhaul; these agents can be layered into your existing processes and adapt to your specific claim workflows. 

The shift from digital to autonomous claims isn’t years away. It’s already happening. Discover how Neutrinos can help you unlock the next level of claims efficiency/claims automation.