In today’s insurance landscape, carriers face a recurring challenge: the decision between fast, efficient off-the-shelf tools and specialized, tailored solutions. When AI technology enters the equation, this challenge grows. Insurers need tools that not only streamline workflows but also adapt precisely to their strict guidelines, regulatory policies, and quality assurance standards.

Enter Agentech—an AI-powered claims processing platform that offers both out-of-the-box efficiency and a highly tailored, carrier-specific component to meet strict insurance requirements. Agentech’s approach balances 80% pre-built functionality with 20% custom-built agents that tailor foundational language learning model (LLM) outputs to your unique QA policies. This 80/20 approach provides the speed and functionality of a ready-made tool combined with a powerful customization component that ensures compliance and alignment with each carrier’s unique guidelines.

Core Features (80% Out-of-the-Box): Meeting General Insurance Needs

Agentech’s pre-built foundation addresses the core demands of claims processing and automation in the insurance industry. With 80% of the platform ready for immediate deployment, carriers benefit from essential features right out of the box:

• Claims Triage and Processing: Automate and prioritize claims based on urgency, peril, or potential risk, ensuring the right adjusters are handling the right claims.
• Data Processing and Compliance Checks: Instantly process and categorize claim-related data, ensuring that information is accessible, organized, and compliant.
• Customer Service Automation: Enable real-time scheduling along with responses to policy inquiries, updates, and routine questions, freeing adjusters for more complex tasks.
• Document Review and File Management: Use AI agents to review, organize, and pull relevant claim information into adjuster workflows for faster and more accurate claim resolutions.

This out-of-the-box structure allows for rapid setup and immediate productivity boosts. But it’s Agentech’s customizable 20% that takes efficiency to the next level.

The Critical 20%: A Team of AI Agents Trained on Carrier QA Guidelines

For insurance carriers, quality assurance (QA) and adherence to strict policy guidelines are non-negotiable. Carriers require that all third-party vendors, including claims processing tools, rigorously follow their specific standards and guidelines. Agentech recognizes this need and has developed a methodology for training our AI agents on each carrier’s unique third-party guidelines. This agent training process forms the essential 20% of the platform, ensuring every claim processed is aligned with the carrier’s exacting standards.

Here’s how Agentech’s agent training process enhances QA and compliance for carriers:

• Guideline-Specific Training: Agentech’s ensemble of AI agents is trained on the carrier’s specific claims guidelines, ensuring that every QA agent is informed by these rules. Whether it’s a compliance check or a procedural requirement, the system directs each AI agent to follow the carrier’s exact standards.
• Real-Time QA Adherence: The trained AI agents have a built-in reference point throughout the claims process, guiding them in real-time to apply the right protocols and adherence checks. This means every decision made during a claim’s lifecycle aligns with carrier policies.
• Dynamic Adaptability: As carriers update their guidelines, the agents can be retrained to reflect the latest standards, ensuring continuous alignment without the need for costly manual updates.

By tailoring our ensemble of AI agents to reflect each carrier’s policies and QA standards, Agentech empowers adjusters and QA agents with an intelligent assistant that both automates and ensures accuracy, making compliance a built-in feature of the claims process.

How Agentech Onboards Each Carrier: QA Discovery Process

To ensure our ensemble of agents meets each carrier’s exact needs, Agentech employs a thorough onboarding and discovery process. This approach allows Agentech to understand both the carrier’s workflow and their specific QA guidelines, producing a solution that not only integrates seamlessly but also enhances compliance. Here’s a snapshot of the onboarding steps:

1. Research: Agentech’s team studies how your adjusters handle claims and reviews your specific QA guidelines to identify key workflow components and compliance requirements.
2. Agent Selection: Based on these insights, we determine which AI agents and QA checks are best suited to meet your claims and compliance needs.
3. Agent Training: We build and train our AI agent teams to reference your carrier-specific guidelines and QA protocols, empowering them to follow each rule precisely during claims processing.
4. Quality Assurance: We conduct human-in-the-loop testing, reviewing outputs for accuracy and adherence to ensure the AI agents perform according to standards.
5. Implementation: Once validated, we integrate Agentech’s customized agents directly into your claims management system, providing seamless, invisible support to adjusters while ensuring compliance.

This onboarding process provides insurance carriers with an AI platform that not only automates but also elevates claims handling with consistent QA oversight with little to no change management.

Specialized Privacy Options for Data Security

Beyond claims processing and QA, Agentech’s onboarding also allows carriers to tailor data security levels. Agentech offers both multi-tenant environments with secure data segmentation and fully private, dedicated databases for carriers with heightened privacy requirements. This ensures that each carrier’s data management aligns with their operational and regulatory standards.

Why Agentech’s 80/20 Model Works for Insurance Carriers

1. Efficiency: Agentech’s hybrid approach of 80% pre-built, 20% tailored provides a rapid setup with the precision of tailored functionality, delivering speed without sacrificing specificity.
2. Compliance and QA: By embedding a specially trained team of AI agents that directly reference carrier-specific QA standards, Agentech ensures compliance from start to finish. This reduces the risk of costly compliance errors and streamlines adherence to carrier protocols.
3. Scalability: As carriers grow, Agentech’s platform adapts to evolving policies and workflow changes. AI agent teams can be retrained and scaled, ensuring that the AI solution continues to meet current and future needs.

Real-World Applications: Agentech in Action

Imagine a carrier processing thousands of claims, each requiring stringent adherence to specific protocols. Agentech’s QA-focused training process directs AI agents to follow carrier guidelines at every step, automating the time-consuming tasks without compromising accuracy. For example:

• Reducing Claims Cycle Times: Agentech automates data entry, compliance checks, and task routing, allowing adjusters to complete claims faster while adhering to every policy requirement.
• Improving Customer Experience: By freeing adjusters from repetitive tasks, Agentech enables them to focus on more complex, customer-centric issues, enhancing satisfaction without sacrificing compliance.
• Automating QA Checks: Agentech’s platform ensures that each claim passes through automated compliance filters, drastically reducing human error and enhancing accuracy across all processed claims.

The Future of Insurance AI: Precision, Compliance, and Efficiency

Agentech’s 80/20 hybrid model—80% pre-built, 20% custom—represents the future of AI-driven efficiency in insurance. While our current focus is streamlining the claims process to help desk adjusters focus on critical decisioning, we’re only just getting started. 

Our model of fast-deployment, ready-made features tailorable to each carrier’s QA requirements will soon provide immense value to the many other workflows straining productivity and efficiency for our clients. 

Ready to implement a claims solution that automates and aligns with your standards? Get in touch with Agentech to learn how our custom-built agents can streamline your claims process.

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