Customer outreach and initial claims triage were handled by staff over phone and email.
With call volume in the hundreds of thousands, policyholders waited for responses, incoming claims were prioritized inconsistently, and staff spent much of their day on routine outreach and intake instead of complex cases. Claims that needed clinical input also had to be routed to state-licensed medical consultants by hand.
ModernEdge built an AI agent for a PE-backed insurer that runs all policyholder outreach, triages incoming claims by type and urgency, and hands them off to state-licensed medical consultants, covering more than 100,000 calls on Claude.
Customer calls the agent now handles that staff previously handled by hand.
Of outreach, triage and handoff to state-licensed medical consultants automated.
Customer satisfaction score after calls with the agent.
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