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AI-Powered Claims Automation for Health Insurers

Prometa.ai partnered with a leading health insurance provider to automate complex claims processing through agentic AI, reducing delays and improving speed, accuracy, and regulatory compliance.

From Challenge to Change

1. Challenge:

Manual claims processing caused delays, inefficiencies, and inconsistent decisions.The insurer needed scalable AI to automate policy validation, document analysis, and decision workflows—across multiple countries.

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2. What We Did:

In 4 months, we designed and delivered a modular, production-ready claims automation system with:

  • Deep process mapping and system design

  • Agentic AI architecture built for diverse claim types

  • Integration with CRM and legacy platforms

  • Human-in-the-loop alignment for compliance

  • Close collaboration with internal teams

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3. Results & Impacts:

  • Automated claim validation and document handling

  • Increased speed and accuracy of processing

  • Deployed globally with minimal local tuning

  • Reduced manual workload for claim agents

  • Ensured long-term sustainability via a 36-month service model

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Trustworthy AI for Complex Decisions

Through intelligent automation and scalable architecture, Prometa helped the client transform claim processing—improving service quality while ensuring traceability and compliance.

In insurance, trust is earned through precision.
Prometa’s AI makes it repeatable.

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