How AI agents will reshape claims and customer service

AI agents are quietly shaping the processing of insurance claims and customer service.

It’s often said that change in the insurance industry happens slowly – until suddenly it doesn’t. Behind the scenes, smart, visionary companies are working to shape the future of insurance services – welcome to the age of AI agents.

Interestingly, we’re not talking about fancy customer apps or shiny front-end portals here. The change is taking place in the background, deep in the operational processes where decisions are made, claims are processed and real added value is gained or lost.

We are entering the age of AI agents. But not the kind that write (often bad) poetry or generate marketing copy. I mean structured, goal-oriented agents that can coordinate tasks, follow logical processes and support real business processes – insurance processes.

This is more important than we might think.

What is an AI agent?

Let’s start with the definition of an AI agent. No, it’s not a chatbot. Nor is it a voice assistant. An AI agent is more of a digital teammate. Let’s think of the processing of a claim, for example. The AI agent performs the following steps: Collect documents, trigger validations, update systems and even notify humans when a decision or escalation is required.

It does not replace people. Rather, it enables them to concentrate on value-adding, creative tasks by taking over the repetitive, invisible and frustrating manual work that makes up the majority of insurance processes today.

Imagine having hundreds of these agents working behind the scenes, keeping the processes running, while your team can focus on the exceptions, the complex cases and most importantly, the customer relationships.

Why claims and customer service are the natural starting points

Claims are probably the moment of truth for every customer. That’s the whole point of insurance – to get help when the unthinkable happens. And yet our industry has a poor reputation when it comes to supporting customers when they need it most.

Insurers have spent years modernizing their claims processes. Most have achieved partial automation, but very few can speak of a seamless process from the first claim report to settlement.

The real obstacles are not just the technology, but also fragmented processes, manual handovers and a lack of coordination.

Customer service faces the same challenge. Insurers have focused more on cost-cutting and nearshoring than on the customer experience. The consequences are obvious: frustrating queues, answers that comply with the rules but are far from solving the customer’s problem.

Ultimately, it’s not about responding faster, it’s about solving problems efficiently – across departments and systems that were never designed to work together.

This is where AI agents supported by orchestration engines come into play. First of all, you don’t have to rebuild your core platforms or put up with months of integration problems. The AI agents simply fit into the existing chaos and bring order.

They connect isolated systems that were never meant to communicate with each other, like digital translators at a dysfunctional family dinner. They can triage incoming requests, route tasks to the right systems or people and follow up with robotic persistence – without reminders or sticky notes.

And unlike human teams spread across time zones and inboxes, they work around the clock, without breaks, burnout or Mondays. They’re not here to impress, but to get the job done quietly, efficiently and without ever asking for a raise.

Beyond the hype

There is no shortage of hype. We have seen demos that look elegant but fail in practice. The insurance industry doesn’t need any more superficial digital tools. It needs an infrastructure that works, even if the rules are confusing and the systems are old and too expensive to replace.

When used correctly, AI agents are not cosmetic. They are back-end enablers. They don’t replace judgment, they improve the process. In combination with powerful orchestration platforms, they can reduce errors, increase consistency and drastically reduce processing times.

Sure, you might want to use AI agents because of the hype or to look better in front of investors. However, the main goal of automation is to get the job done faster, better and in such a way that employees can focus on the essentials.

What you need to get started

Getting started doesn’t require a dramatic technical shift or a burn-it-all-down transformation. Insurers just need to do two things that are less glamorous than a keynote speech, but far more effective.

First of all, take a close and honest look at your current processes: Where are there points of friction, waste, duplication and unnecessary handovers? No filters, no bells and whistles – just a sober inventory of how things really work (or don’t work).

Second, investigate lightweight orchestration layers that act like a digital glue, sitting silently between systems and triggering AI agents to do the repetitive tasks that no one likes to do.

This is not a pipe dream. It’s practical, focused and deeply operational – a transformation that doesn’t make headlines, but makes life easier.

And yes – it is feasible.

Conclusion

AI agents will not revolutionize the insurance industry with a bang. But they will quietly start to change workflows. They will reduce delays, improve accuracy and make life easier for the people who process claims and look after customers every day.

In the long term, this is what makes change sustainable – not hype, but continuous development.

If that sounds unattractive, so much the better. The true revolution is often not particularly attractive.

Mirela Dimofte

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