An agentic AI system can transform businesses today. Industries ranging from healthcare to retail face an ever-growing need for a simpler and more efficient way to verify information in submitted claims. These claims are submitted by customers requesting services, making accurate and timely adjudication critical for businesses’ success.
As a result, many organizations are turning to agentic AI to address this challenge, enabling intelligent automation. It interprets unstructured data, identifies missing details, and applying business rules. This helps streamline claim processing, reduce errors, and improve accuracy. Infoverity recently addressed this challenge by deploying a cutting-edge Agentic AI-driven project that transformed claims processing workflows in just four business days.
In this article, we will review the details of this project, and we will learn more about the impact of AI Agents for claims processing. Keep reading!
Agentic AI: Table of contents
Why Claims Processing Needs Agentic AI Implementation
Manual claims processing continues to be plagued by inefficiencies, particularly given the high volume of digital communications and email submissions that businesses now receive daily. Traditional human-led processes are time-consuming (typically spanning 7-10 business days), prone to errors, and often overburdened by the sheer volume of incoming claims.
To solve these challenges, businesses are increasingly turning to an agentic AI system, a next-generation automation approach that combines data interpretation, intelligent decision-making, and adaptability. For our client Infoverity designed a solution that delivered revolutionary results in less than a week.
The Challenge: Manual Claim Reviews Creating a 10-Day Bottleneck
One of the main inefficiencies in claims processing is the manual review process. When claims are submitted over email, employees must sift through submissions to check for required information. Missing documents or incomplete forms can delay processing further due to constant back-and-forth with customers. Despite efforts to automate these workflows, legacy systems and generic rule-based automation often fail to account for the unique challenges presented by unstructured data or complex claims.
Infoverity’s client needed a system that:
- Automated the review of incoming email submissions.
- Identified and filled gaps in claims data automatically.
- Could adapt to new types of input over time without frequent reprogramming.
- Reduced claim processing times from 7-10 days to a matter of hours.
The Solution: A Custom Agentic AI System Deployed in 4 Days
In response to these pressing requirements, Infoverity tackled the challenge by deploying a customized agentic AI solution in just four business days, transforming the way claims processing operates.
This innovative system operates independently to automate the email review process. It scans and interprets incoming emails to determine whether they contain all the required information for successful claims processing. Gone are the days of meticulously shifting through incomplete submissions. Now this process is streamlined, accurate, and lightning fast.
But its capabilities go far beyond simple detection:
- Smart Data Interpretation: Harnessing the power of unstructured data, the system analyzes emails to find gaps in information and automatically applies business rules to ensure a streamlined workflow.
- Actionable Validation: It prioritizes validated claims, enabling teams to focus their attention on processing rather than reviewing submissions manually.
- Built-in Adaptability: By learning from past interactions and adapting to changing inputs, the system continuously optimizes its performance.
Infoverity’s deployment of agentic AI isn’t just about automating tasks, it’s about enabling smarter, more effective workflows. By integrating decision-making, automation, and adaptiveness, this approach brings unparalleled precision and speed to claims adjudication.
How It Works: A Trio Of AI Agents
The system’s architecture centers on a trio of AI agents coordinated by a Supervisor Agent to automate each stage of the claims validation process.
- Agent One – Email Scan & Extraction: Agent One analyzes incoming emails, extracting essential details such as claim metadata. It also checks for inclusions such as attachments (e.g., PDFs) and flags issues (e.g., missing attachments) to the Supervisor Agent.
- Agent Two – PDF Conversion & Data Processing: The Supervisor Agent activates Agent Two if an attachment is detected. Agent Two converts PDF attachments into machine-readable text, ensuring all required information can be extracted for further processing.
- Agent Three – Completeness Validation: Agent Three checks all extracted details for completeness using pre-configured business rules.
- If the submission is incomplete, the Supervisor Agent drafts a follow-up request for the missing details.
- If the submission is complete, no additional action is needed. The system prepares the claim for efficient downstream processing.
With this multi-agent system, the entire review process runs autonomously, ensuring both speed and accuracy.
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The Result: Faster & Smarter Claims Processing
The implementation of Infoverity’s Agentic AI solution delivered immediate, measurable outcomes, including:
- Processing Time Reduction: Claims processing times shrank from 7-10 days to less than one day. In some cases, the system validated or flagged submissions in a matter of hours.
- Improved Accuracy: By automating rule validation and flagging incomplete claims, the system reduced errors in submission review.
- Operational Cost Savings: Automation eliminated manual workload, allowing teams to focus on higher-value duties such as complex claim adjudication.
- Scalability: The dynamic nature of agentic AI means the system will adapt seamlessly to handle increasing claim volume and evolving workflows.
“This project is not just about plugging in AI to take over important business processes, it’s about scaling automation and intelligence of workflows. In only four days, this helps step us into laying the foundation for transforming industries in this direction. Smarter, well-informed decisions can be made in a more efficient manner.”
Dylan Van Horn, Infoverity Analyst
The Why Behind Smarter Automation
In a world driven by data and dynamic operations, intelligent automation has become essential for staying competitive. Our agentic AI systems are designed to bridge the gap between efficiency and intelligence, offering solutions that not only simplify processes but also enhance decision-making in real-time.
By tailoring each system to the unique needs and workflows of your organization, we unlock the full potential of smarter automation. Here’s how our agentic AI drives impactful results:
- Automated decision-making for complex systems
- Built-in support with existing communication channels
- Decreased hands-on workload and increased accuracy
With agentic AI, automation is not just about speed. It’s about intelligence, adaptability, and delivering meaningful outcomes for your business.
Key Innovation Driving the Use Case Forward
A key innovation driving the speed and efficiency of this project is the use of cloning the database. This approach allows each team member to independently develop and test a copy of their assigned agent.
Moreover, this enables parallel development without interference, which ensures team members can work on different agents simultaneously. Similarly, teams can also collaborate on the development of the super-agent that integrates and coordinates them.
As a result, this use case represents a major advancement in improving customer satisfaction by accelerating the claims process while ensuring all required information is complete and accurate.
Why Infoverity for Agentic AI Systems?
As a leader in data governance, intelligent automation, and AI innovation, Infoverity stands out in executing bold, data-driven solutions that align with specific client needs. With deep expertise in agentic AI, Infoverity can design and implement solutions that drive meaningful results—quickly and reliably.
Our approach emphasizes flexibility and collaboration with existing business systems, ensuring our solutions fit seamlessly into our clients’ environments.
This successful project highlights the vast potential of agentic AI for transforming complex processes like claims adjudication. Whether you’re in healthcare, retail, or another data-intensive industry, Infoverity can tailor intelligent automation solutions designed to elevate your performance.
Elevate your Approach with Agentic AI Today
Agentic AI isn’t just a trend. It’s a game-changer. It empowers organizations to stay competitive, drive growth, and build lasting customer relationships by automating and optimizing every step of the customer journey.
Enhance your strategy with our expert consultancy services. We help you unlock the full potential of your data, improve decision-making, and deliver personalized experiences that boost loyalty, increase revenue, and elevate satisfaction.
Partner with Infoverity today to discover the power of Agentic AI. Request your consultation now to start your data-driven journey.
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