Agentic AI Advances Transform Insurance Operations from Sales to Claims

Agentic artificial intelligence, the next evolution beyond generative AI, is rapidly entering the insurance industry with the promise of transforming not just back-end automation but front-line operations, including claims. Unlike traditional AI tools that assist with tasks, agentic AI models operate with autonomy — breaking down problems, making decisions, and executing multi-step strategies with minimal human intervention. This makes them particularly relevant to insurance professionals tasked with time-intensive processes like claims adjudication, policy review, and fraud detection.

At the ITC Vegas insurtech event, agentic AI was spotlighted for its potential to overhaul the insurance ecosystem, including claim resolution. Applications are being designed to automate everything from initiating first notice of loss (FNOL) to recommending coverage decisions based on verified client data and policy criteria. These systems can act independently — analyzing needs, querying databases, and even initiating client interactions through voice bots. However, regulators continue to require that final sales or binding decisions rest with licensed professionals, keeping humans in the loop.

Claims professionals must also be aware of the risks tied to this innovation. From data hallucination and privacy concerns to compliance with transparency requirements, the technology’s effectiveness depends on clean data and robust oversight. For claims adjusters, this means any AI-enabled decision must be traceable, justifiable, and auditable — particularly in contested or litigated claims.

As agentic AI evolves, it’s clear it will not replace adjusters but redefine their roles. By automating repetitive tasks, such as document collection, communications, and initial assessments, it allows adjusters to focus on complex judgments and high-stakes negotiations. The challenge ahead lies not in developing the tech, but in managing its adoption and integration into legacy systems and workflows. For adjusters and insurance leaders, this shift is both an opportunity and a wake-up call: those who embrace AI smartly could outpace competitors; those who delay risk becoming obsolete.