Agentic AI is changing more than just claims automation—it's changing how claims organizations operate. In this episode, we discuss why insurers need to redesign roles, workflows, governance, and decision-making as AI takes over routine tasks, while humans remain responsible for judgment, oversight, and customer outcomes.

In this episode, we explore why straight-through processing STP), the industry's go-to automation benchmark has become a trap. STP only counts claims that run fully touchless from FNOL to payment and that excludes the 88% of claims that still require human judgment. These claims land on the adjuster's desk and get handled as fully manual, not because they lack automatable work, but because STP's rules ignore them entirely, even when much of the repetitve and routine work inside them can be automated. 

Michael Krikheli, Co-Founder & CTO of Five Sigma, unpacks the three levels of task-level automation—assist, recommend, and execute—and shares how Qover reduced claim costs by 35% by automating work within complex claims instead of chasing a higher touchless-claim rate.

In this episode, we break down the strategy of modernizing your core claims platform the smart way — without gambling operations on a 12–24 month, $5–20M+ core replacement.

We cover how to run agentic AI on top of the system you already have, prove value on live claims first, and let the core migration happen gradually, on your own timeline, instead of as a high-risk, all-at-once cutover.

In this epsode we break down how AI-generated evidence beats behavior-based legacy fraud detection, the signs of a synthetic claim, and what an evidence-first approach looks like in practice.

In this deep dive episode, we trace the shift from AI-assisted tools to fully autonomous agentic AI claims workflows, and why more autonomy doesn't have to mean less control. We cover why traditional model governance falls short on risks like cascading errors, the four guardrails that let you scale safely (role-based access, audit trails, policy enforcement, regulatory compliance), and the 2026 deadlines from Colorado and the EU AI Act.

Every wave of automation in claims sparks the same worry: that the adjuster's job disappears. The honest answer is that it moves up. In this episode, we trace the shift from AI-assisted to agentic AI claims, what changes operationally, and where carriers, MGAs, and TPAs are heading as agentic AI scales across the industry.