Discover how a major international insurance provider used 913.ai’s AI Agent to cut medical claims review times by 70% and boost accuracy to 98%.
-70%
Claim Review Time
-50%
saved monthly
Our client is an global insurance provider serving corporate and institutional clients across multiple industries. Known for handling high-complexity claims, the company manages thousands of medical and disability cases annually, requiring precision, compliance, and strong audit trails.
Like many insurers, the client faced an urgent operational challenge:
40% of total staff work in claims processing, and half of that workforce is set to retire within five years.
Institutional knowledge—critical to resolving complex medical claims—is largely locked inside the heads of experienced adjusters.
Claims processing itself is manual and fragmented, involving PDFs, handwritten notes, doctor evaluations, and other unstructured documents.
The existing systems offered little visibility into why a payment was approved, reduced, or denied.
These inefficiencies resulted in slow, error-prone medical bill reviews and inconsistent disability determinations, creating delays, compliance risks, and dissatisfied claimants.
913.ai developed a specialized AI Agent designed to support, rather than replace, the insurer’s claims processing teams. The solution required no complex training or IT rollout; claims handlers could begin interacting with the AI immediately through a conversational interface.
Here’s how it works:
The AI Agent ingests all claim artifacts (FNOL, medical bills, clinical notes, explanation-of-benefits forms, and images).
It extracts key facts, applies state-specific rules and fee schedules, and computes allowables, reductions, and net payables.
It outputs a concise, table-driven payment packet—including bill-by-bill analysis, PD/TD status with citations, evidence tracking, and suggested next steps.
The result: faster, defensible medical payments with transparent logic that claims handlers can verify in minutes.
This Agent now acts as a real-time assistant, capable of answering follow-up questions, cross-checking evidence, and ensuring that every claim decision is traceable and compliant.
Within weeks of deployment, the insurer saw a measurable transformation in its claims operations.
The AI Agent streamlined the entire medical bill review process, reducing average processing time by over 70% and enabling each claims handler to manage three times more cases per week. What previously required hours of manual review and multiple data checks could now be completed in under an hour, with full transparency into every decision.
Beyond efficiency, the solution also elevated decision quality and compliance. The AI Agent achieved a 98% accuracy rate in payment calculations and delivered 100% audit traceability, ensuring that each medical payment was backed by a clear, documented rationale.
For the insurer, this meant faster turnaround times, lower operational costs, and greater confidence in every claims decision, allowing teams to focus on complex, high-value cases while maintaining full regulatory confidence.
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