AI Automated Insurance
Claims Processing

Automatically process claims in one go with a custom AI Agent trained for your workflow — even if you’re dealing with multiple document types, from medical records to accident photographs.
0% risk of human error
80%-97% workflow automation
20x faster time-to-settlement*
Schedule Free Demo
*based on current client results
How It Works

Send insurance claims to your AI Agent and watch it process them for you with human-like accuracy. It takes just one click.

Mass upload or reroute insurance claims to your AI Agent
AI Agent
extracts key claim details
verifies claim data
classifies claims
suggests data-driven decisions
drafts necessary documents
extracts key claim details
Insurance claims processed
Multimodal vs Ready-Made AI

Get an AI Agent Built to Fit Your
Claims Process

Stop wasting time adjusting to tools built for everyone. Experience real automated claims processing with a tool that adjusts to you.
Multimodal AI Agents
Ready-Made AI
Customized for your use case
—
Pre-trained on public web data
Fine-tuned on your internal guidelines
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Fine-tuned on your existing insurance claims
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Integrated with your software stack
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SOTA Generative AI models
On-going expert support
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20x Faster Claims Processing

Manual claims processing takes days or even weeks. Automated claims processing can take minutes. On average, clients achieve 20x faster workflows with our AI Agents.

Boost Customer Experience

Delight customers and position yourself as the leading insurance company. Artificial intelligence helps you provide lightning-fast feedback without making new hires.

Decrease Your Costs by 80%

Automation helped our clients achieve significant cost savings, averaging around 80% per processed document. You can achieve it, too.

Minimize Errors & Prevent Insurance Fraud

AI algorithms help you eliminate human error, detect fraud faster and more reliably, and spend more time on human review when needed.
“Over the period of a few months, Multimodal delivered something that is traditionally impossible for a software company of any scale. Plus, they have the know-how needed to build AI that outperforms even major industry players.”
Tao Zhang
CTO and Co-Founder @ Caktus

Automate Your Claims Processing in Just 2 Months

Order your custom AI Agent today, and we’llbuild and implement it in as little as 6 to 8 weeks.
Schedule A Free Demo
All-Purpose Tool

End-To-End Claims Process Automation With a Single AI Agent

Replace a suite of tools with a custom AI Agent built for your entire workflow — no matter what it looks like. Here are just some possibilities; you can add more functionalities if needed.
Step 1

Claims Intake & Triage

Automate your claims management process, even if it involves multiple review, analysis, and approval stages. Your AI Agent will adjust to it, automatically processing, prioritizing, and classifying claims in a way that makes sense for your team.
Gather data from disparate sources, like claims and medical records, in one go
Check claims and supporting documents for completeness
Identify claims with special requirements and considerations
Classify claims based on urgency, complexity, or any other variable that matters
Medical Record
Proof of Damages
Accident Report
Step 2

One-Click Data Extraction

Extract all the data you need to make smart claims decisions in one click, no matter if you’re dealing with one or multiple document types.
Convert scanned documents and images to searchable digital formats
Extract relevant data, such as policyholder information, asset details, and diagnoses
Normalize, structure, and review data with ease
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Sarah T.
Data
Diagnosis
Provider
Witnesses
Valuation
Step 3

Data Verification

Automatically compare extracted data to official records, policy documents, and any other documentation that helps you validate the claim.
Determine if the claim is covered by the policy
Verify the claimant’s identity
Validate data authenticity against medical records, police reports, and other supporting documents
Sarah T.
Data Verification
Analysis
Claim Accuracy: 98%
Covered: Yes
Authenticity: 100%
Step 4

Data-Driven Decisions

Your AI Agent can suggest the next steps based on hundreds of data points analyzed, mimicking human judgment almost perfectly.
Suggesting acceptance or rejection of the claim
Determining coverage level
Proposing appropriate indemnity amounts
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Sarah T.
Next Steps
Claim Accepted
Comprehensive Coverage
Step 5

Data-Based Improvement Insights

Your AI Agent can also generate documents that reflect its decisions and analyzed data.
Generate Explanation of Benefits (EOB) documents
Draft denial and claim settlement letters
Generate any other necessary documentation, from revised policy documents to appeal instructions
Explanation of Benefits
Claim Analysis
Step 6

Data-Based Improvement Insights

Finally, your AI Agent can turn raw data into actionable insights that help you make your claims process workflow more effective.
Workflow optimization suggestions
Fraud detection improvement insights
Policyholder behavior insights
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Sarah T.
Insights
Fraud Detection: 3%
Summarize Claim into Email
Why Go with AI?

AI Agents vs Other Claims Processing Systems

See how our Generative AI Agents compareto other claims processing solutions.

OCR Systems vs AI Agents

Optical Character Resolution (OCR) systems have one primary purpose: to convert images and scanned documents into machine-readable formats. This helps automate manual data entry processes and can reduce the risk of errors. Some OCR systems can also extract and verify data found in documents like insurance claims. However, even such more advanced systems don’t understand the data they’re processing. Their lack of contextual understanding makes them more prone to making mistakes, limits their versatility, and makes them unable to handle more complex tasks — such as making data-driven decisions.

Generative AI, on the other hand, does understand context. That’s why it can process and correctly categorize different types of claims, as well as unstructured documents, such as police reports. Unlike OCR systems, Generative AI also doesn’t rely on predefined rules to process claims; it learns how to do so on its own by examining different data. This makes it not only more versatile, but also likelier to accurately process claims it has never seen before. OCR, however, can’t accurately handle claims that don’t perfectly match its expected templates.

AI Agents
OCR Systems
Automation capabilities
Contextual understanding
—
Data-driven decision-making
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Unstructured data handling
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Machine learning
—
Versatility
High
Low
Intelligent document processing
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Unattended, intelligent automation
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RPA Systems vs AI Agents

Robotic Process Automation (RPA) systems are a step up from OCR systems. By using software bots that mimic the actions of human insurance experts, they can automate multistep processes instead of just one partial task at a time. However, just like OCR systems, RPA systems have limited use cases as they need strict pre-defined rules to accurately process documents. This means they also can’t handle unstructured data.

Conversely, Generative AI can learn new rules on its own by handling different data, making its applications virtually endless. They help organizations achieve unattended automation, while RPA systems can, at best, enable attended automation. On top of that, Generative AI can also generate new data, such as claims processing reports and claim decision letters, and make data-based decisions.

AI Agents
RPA Systems
Automation capabilities
Contextual understanding
—
Data-driven decision-making
—
Unstructured data handling
—
Machine learning
—
Versatility
High
Medium
Intelligent document processing
—
Unattended, intelligent automation
—

How it works

Learn how we customize Generative AI models for your unique claims processing needs.

01
Consultation.
We talk to your team to understand your use case and other specific requirements.
02
Customization.
We train the model using your existing documents and on your desired tasks, so it perfectly fits your needs.
03
Integration.
We integrate the model into your other systems, like payment systems or CRM software, so you can streamline your workflow.
Your AI Partner

Why Choose Multimodal?

Developing AI in-house is time-consuming and risky. By partnering with us, you eliminate all risks and get a fully functional solution in two months.
100+
custom Generative AI models built so far
5M+
end users using our AI systems
30+
NLP, ML, data, and MLOps engineers and researchers on our team

Automate Claims Processing in Just 2 Months

Order your custom AI Agent today, and we’llbuild and implement it in as little as 6 to 8 weeks.
Schedule A Free Demo

FAQs About AI Agents for Automated Claims Processing

Are AI Agents compliant with industry regulations?
Yes, we ensure that our AI Agents are compliant with even the most stringent regulations in the insurance industry. This includes regulations such as KYC, AML, GDPR, and others. To do so, we leverage our first-hand experience in the industry and work closely with your team and legal consultants.
Can you help us develop a strategy for AI adoption within our company?
Yes. Please visit our AI Strategy page for more details.
Can I use my AI Agent to process any type of claim?
Yes, you can use your AI Agent to process any type of claim, as we train it for your specific use case. This includes:
‍
1. Health insurance claims
2. Worker’s compensation claims
3. Auto insurance claims
4. Homeowners’ insurance claims
5. Any other type of insurance claim
‍
We can train them to process only one or multiple types of claims depending on your needs.
Who can benefit from automating claims processing?
Healthcare and insurance companies can benefit the most from automating claims processing. Claims automation helps improve time-to-settlement and fraud detection, but it can also enhance other non-core, supportive business processes.

For example:

1. Integrations with customer support systems can improve customer satisfaction and reduce wait times by instantly giving policyholders real-time updates on the status of their claims.
2. Integrations with CRMs can help improve sales and marketing results by giving you more data on your customers.

We are happy to discuss additional integration options during a free consultation.
With which systems can my AI Agent be integrated?
Your AI Agent can be integrated with any system, from core insurance systems to CRMs and document management software.
What if I need more support?
We can provide technical support on an ongoing basis. It includes fixing potential issues, optimizing and evolving your AI Agent over time, and more.
Can I see how automated claims processing works before placing an order?
Of course. Schedule a free demo here. We’ll get back to you as soon as possible.
What are Generative AI Agents?
Generative AI Agents are digital knowledge workers powered by large language models (LLMs) — deep learning algorithms. Unlike previous AI systems, Generative AI Agents can not only process but also generate data, such as Explanation of Benefits (EOB) documents and claim settlement letters.
How accurate are Generative AI Agents when used for claims processing?
Generative AI Agents are extremely accurate when used for claims processing, and may be more accurate than any other available tech solution. This is due to their superior ability to understand human language, such as English or French. This enables them to process and generate data with a high degree of contextual understanding, just like humans do. When it comes to more straightforward tasks, such as data entry and extraction, AI can perform them with unparalleled precision, often exceeding human abilities.
What should I look for in claims processing automation systems?
You should look for five main things in claims processing automation systems:

1. Flexibility. Your chosen system should suit your existing claims processing workflow. Otherwise, you will have to adjust to it instead of it adjusting to you — and probably waste weeks or even months doing so.
2. In-built knowledge of the insurance industry and your claims processing guidelines. Also, your system would ideally be trained on your specific company data, existing claims, and your guidelines. This can drastically influence its accuracy.
3. Integration options. You’ll probably also want to integrate your claims system with your existing software stack, so you can automate your entire workflow instead of just marginal parts of it. Your system should support such integrations.
4. Ease of use. Your system should also be as easy to use as possible. Look for solutions with user-friendly interfaces and no-code or low-code features.
5. Versatility. Finally, your system should help you automate all repetitive tasks within your workflow. Machine learning systems may be the best option here, as they can be trained for almost any knowledge-based use case. They can also learn on their own instead of needing pre-defined rules for every different claim type.
Is automated claims processing better than manual claims processing?
Yes, automated claims processing is generally better than manual claims processing. It removes the risk of human error, helps you reach settlement faster, and allows you to serve more clients in less time — without exposing yourself to fraud.
What is claims process automation?
Claims process automation is a technology-driven process of handling healthcare and insurance claims. It results in claim authenticity validation, data-driven settlement decisions, and, often, the generation of necessary documents, such as EOB documentation.