Driving operational excellence with the power of AI agents for a financial services leader
Introduction
A Mauritius-based financial services leader found itself at a turning point. Despite offering an extensive portfolio of services, manual processes were slowing down its operations, leading to delays, inconsistencies, and operational silos that hindered agility and customer trust.
The organisation realised that to stay ahead in a fast-evolving market, technology needed to become its transformation engine. The goal was clear: harness the power of Agentic AI to reinvent claims management, enhance efficiency, and deliver an experience that sets a new benchmark in the insurance landscape.
Challenges
At the heart of the issue lay one of the most process-heavy functions, claims processing. Manual intervention, fragmented data, and unstructured documentation made it difficult to ensure consistency or scale efficiently.
Key challenges included:
- Inconsistent decisions and limited data capture
- Lack of standardised validation and documentation protocols
- Reliance on tacit knowledge from long-tenured employees
These issues cascaded across the enterprise:
- Operations suffered from backlogs and rising costs
- Finance dealt with payout errors, reconciliation hurdles, and inaccurate reporting
- Customer service struggled with slow and inconsistent claim resolutions
- Compliance teams faced difficulty tracing decisions due to unstructured data
The client needed a solution that could bring order, speed, and scalability, a future-ready, intelligent system capable of transforming claims operations end-to-end.
The challenge: A call for consistency, speed, and intelligence
The Deloitte solution: Building a scalable, Agentic AI-powered claims ecosystem
The Deloitte team began by mapping the as-is and to-be claims lifecycle to uncover pain points and automation opportunities. This groundwork laid the foundation for a modular, multi-agent AI ecosystem designed to streamline decision-making and accelerate processing.
Key components of the solution included:
- LangChain and LangGraph to orchestrate dynamic, stateful agent workflows
- Large Language Models (LLMs) to enable reasoning, document interpretation, and decision support
- Embedded business logic combining policy data, historical claims, and customer profiles for contextual accuracy
- Secure deployment of specialised AI agents, including:
- Document Extraction Agent: Extracting key fields from prescriptions and pharmacy bills
- Claim Screening Agent: Validating doctor credentials and required documentation
- Claim Vetting Agent: Assessing policy coverage and eligibility
- Notification Agent: Communicating real-time updates to customers
Together, these agents created a self-orchestrating, intelligent workflow capable of driving accuracy, speed, and transparency, all while maintaining human oversight where needed.
The impact
The first wave of deployment, focusing on dental claims processing, delivered immediate and measurable results:
- ~80% automation of a key claims category, significantly cutting manual intervention
- 30% reduction in operational costs through workflow optimisation
- 15% higher customer retention and 20% growth in cross-sell conversions due to faster resolutions and improved experience
- Enhanced compliance and decision-making with structured data and standardised documentation
The transformation didn’t just improve efficiency, it unlocked new potential for innovation, insight, and growth.
The road ahead: Scaling intelligence across the enterprise
With its modular architecture and scalable design, the Agentic AI solution is now set to extend beyond claims into other business functions. The client is poised to continue its journey, driving operational excellence, accelerating innovation, and reinforcing its leadership in the financial services landscape.
From manual to intelligent, results that speak for themselves
Christine Ahn
