By Third Rock Techkno

Insurance customers today demand fast, transparent, and hassle-free claims processing. Traditional portals, overloaded with manual tasks and paperwork, fail to meet these expectations, causing customer churn and operational inefficiency.

This guide walks you through building a modern AI-powered insurance claims agent from core technology components to deployment that can transform your claims processing in 2025 and beyond.

Understand the Claims Processing Workflow

Before you build, map out the claims workflow from submission to resolution. Here’s a simplified claims flow:

1. Claim Submission: Customer uploads claim form, photos, or voice notes via portal or app.
2. Data Extraction: AI extracts relevant info from documents using OCR and NLP.
3. Claim Validation: AI checks data integrity, detects possible fraud.
4. Claim Processing: Backend systems process claims, update status.
5. Customer Notification: Real-time updates sent to the customer via portal/app/email/SMS.
6. Claim Resolution: Claims approved, rejected, or escalated for human review.

You can use your existing Claims Workflow Diagram here to visualize these steps.

Set Up Your Development Environment

You’ll need: