Industry
Banking
Banking Services Transformation: Unlocking Exponential Value
Highlights
- TCS Agentic Claims Processing reimagines claims with agent-driven workflows to boost efficiency, optimize turnaround time and customer experience.
- This solution enables intelligent, context aware decision-making using AI agents trained on insurance-specific data and regulations.
- It delivers measurable impact including faster processing, reduced errors, and stronger compliance oversight.
On this page
Overview
TCS Agentic Claims Processing Solution is an AI-native platform that reimagines insurance claims management as an adaptive, agent-driven process. By embedding intelligence across the value chain, it improves efficiency, reduces turnaround time, and enhances customer experience. The solution built on agentic AI, manages complex workflows, supports expert-level decision-making, and integrates seamlessly with enterprise systems. It moves beyond traditional robotic process automation (RPA) and rules-based automation to deliver context-aware claims processing.
Solution
At its core the solution is a network of intelligent agents powered by fine-tuned large language models (LLMs) trained on insurance-specific data, National Association of Insurance Commissioners (NAIC) regulations, and more.
The intelligent agents’ reason across structured and unstructured data, invoke external tools, and make nuanced decisions that reflect deep domain expertise.
Benefits
Building on the power of agentic AI the solution brings together modular agents, contextual insights and enterprise integration to deliver a truly next- generation claims processing experience.
- Nuanced decision making: Intelligent agents infer context and adjudicate claims based on diverse data, mirroring expert reasoning
- Tool interoperability: Agent interacts with external systems and APIs for real-time, contextual data access.
- Multi-agent collaboration: Modular agents work in parallel to handle intake, triage, NIGO Checks and Adjunction.
- Auditability and oversight: Every decision is explainable and traceable, with guided checkpoints ensuring regulatory compliance and accountability.
Why choose TCS Agentic Claims Processing?
- Move beyond traditional “AI assist” models to true AI autonomy, empowering insurers to transition from decision support to full decision execution.
- Set a new benchmark in insurance innovation with production-grade GenAI embedded across the claim’s workflow raising expectations for what scalable AI can deliver.
- Designed for insurers ready to move beyond pilots, this solution acts as a proven blueprint
The TCS advantage
Deep insurance domain expertise
With over two decades of experience in the global insurance landscape, TCS brings unmatched depth in claims operations. The solution is infused with domain-rich agentic flows tailored for diverse insurance lines workers' compensation , auto, property, and disability ensuring contextual intelligence and expert-like reasoning at scale.
Fine-tuned, task-specific models
The solution includes LLMs fine-tuned specifically for litigation scenarios—trained on NAIC regulations, historical court rulings, and insurance legal terminology to support accurate, defensible decision-making in complex claims. This demonstrates our ability to build industry-grade models for high-impact tasks. With TCS’ enterprise AI capabilities, similar fine-tuning can be extended to other claim processes using carrier-specific knowledge, enabling creation of custom models aligned to each insurer’s proprietary data, workflows, and regulatory environment.
Plug-and-play architecture
The solution is designed for seamless enterprise adoption with prebuilt adapters for industry-standard core systems. Modular APIs and tool abstraction layers enable easy integration, without disrupting existing IT landscapes.
Robust evaluation and traceability framework
The solution incorporates a comprehensive evaluation framework purpose-built for insurance. With trajectory-level logging, decision traceability, and compliance-grade audit trails, it ensures transparency and trust in every agent action.
Human-in-the-loop by design
Blending automation with oversight, the solution allows claims professionals to review, override, or co-pilot decisions through an intuitive interface. The system learns from each interaction—continuously refining agent performance and trustworthiness.
Enterprise-scale and cloud native
Built on a scalable, cloud-native foundation, the solution can handle high-volume claims across geographies with ease. TCS ensures enterprise-grade security, performance, and reliability—backed by global delivery, managed services, and continuous support.
Claims intelligence in practice
Workers compensation and disability lines of business
TCS Agentic Claims Processing supports the automation of workers compensation and disability claims by leveraging specialized AI agents. These agents extract and interpret information from various data sources such as doctor’s notes, employment letters, and claim forms. By reasoning across these inputs, they assess compensability with high accuracy. The solution uses fine-tuned language models to evaluate compliance aligned with state-specific regulations, NAIC guidelines, and legal precedents ensuring that decisions are fair, consistent, and defensible.
Auto adjudication pipeline
The auto adjudication pipeline enables end-to-end claims processing through modular AI agents:
- Document and image ingestion: Processes police reports, garage bills, photos, and other claim-related documents.
- Data extraction agents: Identify key entities like damage areas, timelines, and involved parties.
- NIGO agents: Validate document completeness and consistency across all inputs.
- Evaluator agents: Cross-verify narrative and damage descriptions against images for accuracy.
- Anomaly detector: Detects discrepancies between claim narratives and evidence, flagging issues early.
Projected business impact
- 30–50% reduction in manual errors through intelligent validation.
- 2x faster claim processing compared to traditional workflows.
- Up to 70% improvement in fraud detection accuracy through multimodal analysis and reasoning agents.
- Stronger compliance and customer experience through real-time guidance, audit trails, and human-in-the-loop oversight.