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Reimagining Claims Adjustment with Amazon Nova AI
Client
A leading global insurance provider headquartered in the United States manages a vast portfolio of policies and claims across multiple regions and customer segments. The organization operates within a highly competitive and regulated industry, where operational agility, transparency, and customer trust are critical success factors.
As claim volumes surged, the company’s traditional claims adjustment process — largely dependent on manual review, fragmented data systems, and human discretion — struggled to keep pace. The absence of unified intelligence across claim intake, validation, and fraud detection created inefficiencies that directly affected cost structures, profitability, and the overall customer experience.
Business Challenge
The client’s legacy claims adjustment processes were manual, inconsistent, and slow, often taking five to ten days to resolve a single claim. Claims adjusters were burdened with high workloads and subjective decision-making, resulting in process variability and inconsistent customer outcomes.
The challenges included:
- Extended claim resolution timelines, leading to customer dissatisfaction and higher administrative overhead.
- Subjective claim assessments that increased operational risk and reduced accuracy in loss evaluation.
- Profit leakage of up to 20%, primarily from undetected or late-detected fraudulent claims.
- Fragmented data sources across claim management systems, which limited visibility and prevented comprehensive analytics.
- The inability to ensure speed, fairness, and transparency in claim handling due to siloed systems and reactive workflows.
As claim volumes continued to rise, these issues collectively strained operational efficiency, reduced profitability, and weakened customer confidence.
Approach
Trianz engineered a multi-agent framework powered by Amazon Nova to transform the insurer’s claims management ecosystem into an intelligent, autonomous operation.
The solution involved:
- Developing Nova-powered agents to automate claim intake, validation, fraud detection, and communication workflows.
- Leveraging Amazon Nova Sonic and Nova Pro models for advanced reasoning, contextual understanding, and decision accuracy across complex claims scenarios.
- Introducing conversational AI interfaces that interact empathetically with claimants, providing real-time status updates and guidance throughout the adjustment process.
- Embedding compliance-by-design within the framework to ensure all decisions, communications, and data flows adhered to regulatory standards.
- Enabling autonomous orchestration among agents, allowing the system to process claims end-to-end with minimal human intervention while maintaining explainability and auditability.
By combining Amazon Nova’s advanced GenAI capabilities with Trianz’s agentic design methodology, the client transitioned from reactive claim handling to proactive, intelligent claims management at scale.
Technology Components
AWS Services
Monitoring
Data Integration
ETL
Project Management
Transformational Effects
straight-through processing (STP)
reduction in operational costs
faster claim resolution
reduction in profit leakage
The adoption of the Nova-powered agentic AI framework delivered measurable business impact across multiple performance metrics:
- Achieved over 90% straight-through processing (STP) achieved, drastically reducing manual touchpoints in claims handling.
- Saved 35% reduction in operational costs, driven by automation of repetitive processes and elimination of surge staffing during peak claim periods.
- 60% faster claim resolution,improving customer satisfaction and accelerating financial recovery cycles.
- 20% reduction in profit leakage, enabled by early fraud detection and consistent claim validation.
- Elimination of surge staffing requirements, as the system scaled autonomously with claim volume fluctuations.
- Enhanced customer experience, with always-on, empathetic, and transparent claim interactions through conversational AI.
Through this transformation, the client redefined its claims management operations—evolving from a manual, error-prone process to an autonomous, Nova-powered agentic ecosystem that delivers fairness, speed, and trust at scale.
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