How to turn insurance claims into competitive edge with human-centric agentic AI

For years, insurers have invested heavily in digital transformation. Yet even today, many claims journeys can feel fragmented. Customers still repeat information across channels and wait, sometimes for days, for status updates.

The result is friction, and friction erodes customer trust faster than any price increase ever could. According to industry data, claims handling accounted for by far the most (62.4%) of insurance customer complaints in 2024.

So where do the real challenges lie, and how can agentic AI help? 

Claims challenges are often attributed to volume: catastrophic events, seasonal spikes, and unpredictable surges create operational strain. But the deeper problem is complexity.

A single claim touches multiple systems and stakeholders:

• Assessing coverage
• Running fraud checks
• Collecting documentation
• Coordinating third parties
• Adjusting the claim
• Processing payment - all while maintaining compliance.

Often, each step exists in its own workflow. Data can sit siloed in disconnected systems with little shared context. That’s why customers experience delays, disconnection and frustration - not because agents aren’t working hard, but because the infrastructure wasn’t built for the customer journey.

Agentic AI creates a genuine opportunity to shift claims from process-centric to customer-centric, coordinating every step around the policyholder, rather than requiring the policyholder to navigate the organization.

Customers want responsiveness, but they also want compassion. What agentic AI makes possible is intelligent orchestration – in real time – that breaks down data silos, automates decisions and actions where appropriate, and empowers agents with the tools to do their best work. The goal isn’t fewer interactions; it’s better ones.

Insurance leaders are listening. Insurance industry statistics in 2026 reveal that agentic AI adoption is set to rise from 14% to 70% by 2028. Approximately 40% of insurers now report tangible business benefits from AI, with 77% of those benefits linked to productivity gains. What’s more, claims handling is the top target for AI integration, with 67% of industry respondents identifying it as a primary area for improvement. 

The first interaction sets the emotional tone for the entire claim. When customers are stressed, they need simplicity, not forms, transfers or long hold times.

Instead of asking customers to “file a claim” insurers can ask them to simply describe what happened. Agentic AI-enabled intake can:

• Capture claim details through conversational voice or chat
• Pre-populate policy and coverage data automatically
• Detect urgency and route to the right resource
• Provide clear, immediate next-step guidance.

The experience becomes supportive, not transactional.

Not all claims require the same handling. A cracked windshield should not follow the same process as a major liability event. Agentic AI can evaluate claim characteristics in real time - policy type, loss indicators, historical patterns - and determine the optimal handling path, from straight-through processing for simple cases to adjuster escalation and special investigation of complex ones.

This reduces cycle times, improves consistency and compliance, and ensures every policyholder gets the level of attention their claim warrants.

One of the most common frustrations in insurance is uncertainty. Customers tend to call because they don’t know what’s happening. This drives up queue times, adds strain to contact centers, and degrades the overall experience.

Agentic AI-driven engagement enables insurers to:

• Send milestone-based updates automatically
• Explain next steps in plain, jargon-free language
• Anticipate and answer common questions proactively
• Provide estimated timelines and manage expectations.

When customers feel informed, they feel cared for. And when they feel cared for, they stay loyal - even after a loss. 

The claim shouldn’t be the end of the journey: it’s the beginning of retention. AI enables insurers to identify meaningful follow-up opportunities: gathering feedback, pinpointing gaps in coverage, and offering guidance that helps customers better protect themselves. 

Claims handling is more than just a process. Human agents interpret context, act with sensitivity, and guide customers through some of the hardest moments of their lives. AI should enhance that kind of expertise, not remove it.

In real time, AI copilots can equip human agents with:

• Relevant policy language surfaced instantly
• Summaries of previous customer interactions
• Recommended next actions
• Auto-generated documentation and call summaries
• Compliance flags before they become problems.

The result is faster resolution, higher quality and a lighter administrative burden. Agents spend less time searching systems and more time caring for customers.

The technology is powerful, but it’s easy to rush the transformation and create more complexity than you started with. The real challenge is moving from AI pilots to enterprise-scale deployment.

Working with insurers, we’ve seen three common pitfalls to avoid:

• Fragmented point solutions: disconnected "black box" bots across departments create unscalable, unmaintainable messes
• Vendor lock-in: proprietary AI toolsets create technical debt as capabilities evolve rapidly
• Overlooked governance: leading to problems with data compliance, cybersecurity and explainability of AI decisions. 

A better approach starts with clarity. Analyze your current customer experience processes, map the business outcomes that matter most, and identify where AI will genuinely drive ROI. From there, define a clear roadmap:

• Which processes should remain fully human-led
• Which should be AI-augmented
• Which should be redesigned as agentic-first from the ground up.

Choose solutions that are enterprise-ready, enabling you to minimize time to market and mitigate business risk. Make sure AI observability, security and compliance are built in, not bolted on. And choose a route that gives you agility and future-proofs your agentic AI so that you avoid being caught by the next wave of the AI hype cycle.

Agentic AI gives insurers the ability not just to automate, but to transform every touchpoint on the claims journey, with AI and people working seamlessly together.

Customers want faster, simpler, digitally-enabled claims experiences. But they still value human connection in the moments that matter, especially in complex or emotionally charged situations. At Konecta, working with leading insurers, we are already seeing multiple measurable benefits of human-centric agentic AI in claims - including a 40% reduction in claims processing times.

Insurers who close the gap between AI pilots and enterprise-scale claims experiences will gain a decisive competitive edge, and earn customer loyalty that lasts.