AI in claims handling: what can an agent take on in a complex claim?

Examples of agents we build for claims teams

Each agent is custom-built on your own tools; a few examples:

• The first notice agent: reads a claim reported by email, form or phone, opens the file in your claims system and lists the documents to request.
• The inbox agent: files incoming photos, quotes, invoices and reports into the right claim and alerts the handler in charge.
• The documents agent: keeps track of what is missing from each file and chases the policyholder, the adjuster or the broker.
• The adjuster report agent: summarizes each loss adjuster's report with page references and flags what has changed since the last one.
• The coverage agent: matches the circumstances of the loss against the policy schedule and wording, and points the handler to the clauses to examine.
• The deadlines agent: tracks notification, inspection and settlement deadlines on every file, and alerts you before a file goes quiet.
• The invoice check agent: compares quotes, invoices and the adjuster's assessed amounts, and flags gaps before settlement.
• The recovery agent: gathers the evidence of the third party's liability, builds the timeline and drafts the subrogation memo.
• The field agent: answers the adjuster or inspector on site through WhatsApp, and files the photos and voice notes they send into the claim.
• The management agent: prepares a weekly view for the head of claims of open files, reserves and recovery claims in progress.

Can it tell us what is in a file and what is missing?

First notice of loss, incident report, photos, quotes, invoices, policy schedule, emails with the policyholder and the broker: a complex file grows fast. The agent reads it, lists the documents received and the ones still missing, and drafts the request to each party.

Reminders go out once approved, or automatically for a simple document request if you have chosen that. Every morning, the handler sees which files are complete and which are still waiting on someone.

Can it summarize a loss adjuster's report?

An adjuster's report on a commercial fire or water damage claim often runs to dozens of pages, plus appendices. The agent writes a summary: cause and circumstances, damage found, amounts assessed, the adjuster's reservations, each point referring to the page it comes from. From one report to the next, it flags what has changed.

It also checks the amounts retained against the quotes and invoices on file, and flags gaps to examine before settlement.

Can it draft letters to the policyholder, the adjuster and third parties?

Acknowledgement, document request, status update, a letter setting out the position taken: the agent drafts them in your Word templates, from the file and the latest exchanges.

A letter accepting or declining a claim states the handler's decision and goes out once the handler approves it. An acknowledgement or a document request can go out automatically if you choose.

Can it prepare a subrogation claim against a liable third party?

A recovery claim needs everything that shows the third party's liability and the amount paid: adjuster's report, incident report, witness statements, settlement receipts, correspondence with the other insurer. The agent gathers these, builds a timeline of the file and drafts a recovery memo, each fact pointing to its source.

It also spots settled files where a third party appears to be involved and no recovery has been opened, and tracks the limitation periods of recovery claims in progress.

Can it find a comparable claim or an internal procedure?

Closed files and claims procedures hold the answers to the questions handlers ask every day. Saména reads these documents and finds a comparable file by type of loss, coverage or adjuster, citing the source.

You then ask the way you would ask a colleague who had read everything:

• Have we had a business interruption claim from a client in this sector before?
• What is our procedure when a second adjuster is appointed?
• Which recovery claims have we brought against this insurer in recent years?

Where do our policyholders' files go?

A claim file holds personal data about policyholders and third parties. Your files stay in SharePoint, OneDrive or Dropbox. Saména reads them in read-only mode and keeps no copy. What it retains is encrypted with a key unique to your company.

Processing servers are in France, the database is in the European Union. You choose the model: Claude, models from OpenAI, or Mistral if you prefer a French model. It runs in Europe and keeps none of your data. If your requirements call for it, Saména can run on your own infrastructure, and everything can be deleted on request.

Where do we start?

With a half-hour call. We look at how your handlers work, from opening a file to settlement and recovery, with which tools, and pick the first agent to build together.

Our engineers build it on your tools: it is usually running two weeks after the call, in the Saména app and also from Claude, ChatGPT or Copilot. They then stay on to keep it evolving and build the next ones. There is a one-time setup fee, then a monthly subscription; we share the amounts on the call.

Frequently asked

Does the agent decide whether a claim is covered?

No. The agent reads, summarizes, checks and drafts. The coverage position, the reserve, the settlement and any recovery stay with the claims handler.

Can the agent connect to our claims management system?

Yes, that is the point of a custom build: we connect to the tools you already use, claims system, email, telephony, SharePoint, OneDrive or Dropbox. We look on the call at how to connect to yours.

Can we start with one team or one type of claim?

Yes. You can start with one team and a first agent, for example on commercial property claims, then expand whenever you want.

Does Saména already work with insurers or claims administrators?

Saména currently works with a consulting firm, an environmental engineering consultancy and a network of car repair garages, and each agent is built around the way the company using it works. The first call is there to see what an agent would take over for you.