Xebia's Agentic Claims Suite
From claims suite to autonomous claims - let AI agents do the heavy lifting while your people make the calls that matter.
Book a meetingXebia’s Insurance Claims solution gave insurers a unified view. The fully agentic behavior now takes the next step: multiple specialized AI agents that actually work the claim, end to end, from first notice through settlement, recovery, and closure. Your adjusters stop chasing data and start making decisions. Fraud gets caught earlier. Customers get answers faster. And everything the agents do is logged, explainable, and auditable.
Built on Appian and delivered by Xebia, the Agentic Claims Suite is designed for insurers who have already centralized their claims data and are ready to put that data to work with autonomous, intelligent processing.
The Business Challenge
Unified data alone isn't enough
Having a single view of the claim was a critical first step. But a dashboard still needs someone to look at it, interpret it, and act on it. When volumes spike, the queue grows faster than your team can work it.
Rising loss-adjustment expense
Most of the cost of a claim is not the payout itself - it is the handling. Every touch, hand-off, and re-work step adds to LAE and erodes the combined ratio.
Cycle times that don't match customer expectations
A claim can sit in a queue for days before anyone looks at it. Traditional pipelines were built around queues and hand-offs, not speed, and policyholders feel it.
Fraud that rules engines can't catch
Organized fraud rings, staged accidents, and opportunistic exaggeration cost the industry billions a year. Rules-based detection produces too many false positives and still misses the patterns that actually matter.
Adjusters doing the wrong work
Skilled adjusters spend most of their day on data entry, document chasing, and routing decisions instead of the judgment calls they were hired for. Attrition is rising, and new joiners take months to ramp up.
Disconnected intelligence
Even with a Claims 360 view, insights into fraud patterns, settlement benchmarks, litigation risk, and recovery opportunities reside in separate systems and under separate heads. No single brain connects it all.
Key Features:
Multiple specialized AI agents, coordinated by a Master Orchestrator
The suite deploys a team of AI agents - each an expert in its domain. FNoL Intake, Triage and Routing, Fraud Detection, Settlement, SIU Investigations, Litigation, Recovery, Field Inspection, Customer Communications, Compliance, Process Mining, and Executive Intelligence. A Master Orchestrator decides which agents work on which claims, in what order, and when to loop in a human.
Autonomous first notice of loss
The FNoL Agent reads incoming claim packets - documents, photos, voice transcripts - and turns them into a clean, structured claim in under seconds. It enriches the record with policy data, weather, telematics, and prior claim history, and pushes the finished claim into the right queue. No manual data entry. No re-keying.
Intelligent triage and routing
Every new claim is scored for complexity, severity, and fraud risk on arrival. Simple, low-risk claims can be auto-settled. Complex ones go straight to the right team with the right context already attached. No more generic queues. No more mis-assignments.
Fraud detection that sees the whole picture
The Fraud Agent evaluates each claim against more than fifty signals - prior claim patterns, network relationships, medical provider watch-lists, staged-accident playbooks, and behavioural indicators.
It produces an explainable fraud score, and shows its reasoning behind every flag so your SIU team can act on real intelligence, not noise.
Claims Copilot - a single-screen, conversational workspace
Adjusters work inside a single screen where they can ask questions in plain English, pull up any claim, run fraud analysis, draft settlements, or take action - without switching tabs or navigating between systems. Every response is grounded in real claim data. Every action leaves an audit trail.
Human-in-the-loop where it matters
Low-confidence decisions, high-value payouts, and regulated actions are routed to a human with full context and a one-click approval gate. People stay in charge of the calls that matter. Agents handle the volume.
End-to-end lifecycle coverage
The suite handles the claim from intake through inspection scheduling, fraud screening, settlement drafting, subrogation identification, litigation strategy, customer communications, and final closure. Not one step - the whole journey.
Built-in compliance and audit trail
Every agent action is logged with a timestamp, confidence score, and reasoning. Regulators, auditors, and internal risk teams get a complete, machine-generated trail without anyone having to write a separate report.
Real-time executive intelligence
The Executive Intelligence Agent continuously tracks claims KPIs - cycle time, LAE, fraud recovery, CSAT, auto-settlement rates, adjuster utilization - and surfaces insights that would take a reporting team days to compile.
The Business Impact:
Shorter cycle times
Routine claims move from intake to settlement in hours, not days. Adjusters spend their time on the claims that actually need judgment, and customers get answers faster.
Lower handling cost per claim
Automating repetitive work across intake, triage, documentation, and closure reduces loss-adjustment expense while maintaining high quality and compliance.
More fraud caught, fewer false positives
Context-aware fraud detection finds what rules engines miss and stops flooding Special Investigations Units (SIU) with noise. Investigators spend their time on the cases that are actually worth pursuing.
A better experience for policyholders
Customers get timely, personalized updates through the channel they prefer, can check status on demand, and see their claims resolved faster. NPS and retention move in the right direction.
Higher adjuster productivity and satisfaction
Agents absorb the work that adjusters find draining - the data entry, the document chasing, the routine routing. New joiners ramp faster because Claims Copilot carries the tribal knowledge. Retention improves.
A single, intelligent view of every claim
Policy, incident, evidence, agent findings, and communications all live in one place with a full audit trail. Decisions are made on complete, current information - not fragments pulled from five different systems.
Scales with the business
The agentic architecture lets insurers add new agents, plug in new data sources, and extend into new lines of business without re-platforming. The suite grows with your book.
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