How a Tier-1 P&C Insurer Rebuilt Claims Operations Around an Agentic AI Workforce
How a Tier-1 European Property & Casualty insurer replaced a manual claims pipeline with an agentic AI workforce intaking FNOL documents, scoring fraud signals, drafting reserve estimates, and routing complex cases to the right adjuster, all before a human reads the file.
A Claims Pipeline Built for Paper, Not for Policyholders
FNOL Stuck in Inboxes
First Notice of Loss arrived as PDFs, scans, and photo bundles that adjusters had to open, read, and key into the core system by hand.
14-Day Average Cycle
From notification to payout, the median claim was taking two weeks half of that time was waiting in queues, not actual decision work.
Inconsistent Triage
Two adjusters looking at the same claim could assign different severity and different reserve estimates. The downstream cost was real.
Fraud Found Too Late
Suspicious patterns surfaced only after payouts, in monthly audits. By then the money had moved and recovery was effectively impossible.
Policy Lookup Tax
Every complex claim demanded that an adjuster hunt through hundreds of pages of policy wording to confirm coverage, sublimits, and exclusions.
NPS Slipping Quietly
Policyholders went silent in the gap between filing and decision. By the time a verdict landed, the relationship had already cooled.
At Metizsoft, we don't just rebuild stores we own the outcome. Three pillars: earn belief, personalize discovery, then loop the customer back in.
An Agentic Workforce, Not Another Workflow Tool
Rather than digitize the existing process step-for-step, the team rebuilt claims operations around a Supervisor Agent that delegates each task to a specialist and routes only the genuinely complex cases to human adjusters.
Triage at the Front Door
Every claim is read, classified, and reserve-estimated before it ever lands in an adjuster queue no inbox triage, no manual keying.
Specialists Over Generalists
Six narrow agents handle intake, severity, fraud, policy lookup, reserve drafting, and compliance each better at its job than a single model would be.
Human-in-the-Loop for the Hard Cases
Routine claims are auto-decisioned with audit trails. Edge cases land on a senior adjuster's desk with full context already gathered.
Designed for Clarity, Built for Speed
A seamless call-to-booking flow that handles everything from speech recognition to CRM sync without any human touchpoint.
Six Agents Inside the Claims Workforce
FNOL Intake Agent
Reads claim PDFs, scanned forms, and photo bundles, extracts the structured fields, and opens a clean case file in the core system.
Severity Classifier
Scores complexity and damage severity from intake data, assigning each claim to a track fast lane, standard lane, or specialist review.
Fraud Signal Agent
Cross-references the claim against known patterns, prior incidents, and document anomalies, flagging risk before any payout is approved.
Policy Q&A Agent
RAG-powered lookup across policy wordings, endorsements, and reinsurance treaties adjusters get the right clause in seconds, not hours.
Reserve Drafting Agent
Proposes initial reserve estimates from historical claim data and current exposure, giving adjusters a starting point grounded in the book.
Compliance Auditor
Logs every decision, source citation, and model output to a tamper-evident audit trail aligned with regulator expectations.
From Audit to Live Operations, in 4 Stages
Every reported metric is measured from production claims, not pilots cycle time from core system timestamps, accuracy from blind-graded samples.
Audit
Mapped the existing claims journey, sampled three years of FNOL data, and identified where time and accuracy were actually being lost.
Train
Built and fine-tuned each specialist on the insurer's own historical claims, policy library, and fraud cases grounded in their book, not generic data.
Integrate
Wired the workforce into the core claims platform, document store, payment system, and audit log through secure APIs and event streams.
Operate
Launched in shadow mode, then live with adjuster oversight. Performance dashboards and drift monitors keep the agents honest in production.
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