The insurance claims experience is the single moment that determines whether a customer remains loyal or becomes an advocate for your competitor. Research consistently shows that customers who experience fast, empathetic, and transparent claims handling are significantly more likely to renew, increase coverage, and recommend. Yet the average insurance claim in 2025 still takes days to process — with multiple handoffs, manual reviews, and customer callbacks that compound the frustration of an already stressful event.

Deloitte’s agentic AI research provides the benchmark: AI-driven claims orchestration reduces cycle times by up to 80% in financial operations workflows. (Source: Deloitte, “Agentic AI Use Cases in Financial Services,” 2025) For insurers still operating manual claims processes, this figure represents not just an efficiency gain — it represents an existential competitive threat.

The 2028 Claims Landscape

By 2028, the insurance claims landscape will be bifurcated: AI-native insurers that process straightforward claims in hours, and legacy insurers that take days. By 2029, Gartner predicts 80% of common customer service issues — including claims status inquiries, basic claims filing, and straightforward damage assessments — will be resolved autonomously by AI without human intervention. (Source: Gartner, March 2025)

The implications for customer acquisition and retention are stark. Insurers who cannot deliver near-instant claims experience will lose customers to those who can. And in a market where claims handling is the primary differentiator — customers care far less about premiums than they do about whether their insurer comes through when something goes wrong — the competitive stakes could not be higher.

What AI-Orchestrated Claims Processing Looks Like

The AI-orchestrated claims journey for a straightforward property claim in 2028 looks like this: the customer notifies the insurer via app, web, or voice; AI extracts first notification of loss data and creates a case instantly; document AI processes supporting photos, documents, and third-party reports in seconds; fraud screening AI runs pattern matching against historical claims data; coverage rules AI verifies policy terms and eligibility; the customer receives an AI-generated settlement offer or further information request within hours.

Pega Customer Service orchestrates this entire journey — connecting claim intake, document processing, compliance checks, fraud screening, and customer communication in a single workflow that executes faster than any manual process and with superior auditability.

The Agent Empathy Layer

Deloitte’s research adds a critical insight to the AI claims story: AI-supported agents are 35% less likely to feel overwhelmed during emotionally complex customer interactions. (Source: Deloitte, 2025) In insurance claims — where customers are frequently distressed, grieving, or frightened — agent emotional capacity is as important as processing speed.

The ideal architecture uses AI to eliminate every administrative burden from claims agents: document retrieval, compliance checks, coverage verification, and case logging all happen automatically. The agent arrives in the conversation with full context, AI-generated next-best steps, and zero administrative distraction — free to focus entirely on the customer’s emotional state and on resolving their claim with genuine care.

Building Your Insurance AI Claims Roadmap

The path to AI-orchestrated claims handling in insurance begins with a workflow audit: identifying the highest-volume, highest-friction steps in your current claims process and mapping them to automation opportunities. Novitates offers a focused Claims Automation Assessment — a structured engagement that benchmarks your current claims handling against best-practice AI architecture and delivers a prioritised roadmap for transformation.

Pega Customer Service for Insurance provides the platform foundation. Novitates provides the BFSI expertise to implement it correctly.