Solution

AI-powered claims by Capgemini

Unlock the full potential of AI-powered claims by Capgemini.

Surging loss costs, rising adjustment expenses, and declining customer satisfaction are putting increasing pressure on insurers to modernize their claims organizations. At the same time, claims teams are handling higher volumes with limited automation, slowing cycle times and increasing leakage.

Capgemini helps insurers improve claims performance by embedding AI directly into their claims workflows – from intake and triage to decisioning and settlement. The result is shorter cycle times, reduced leakage, more consistent outcomes, and a clearer, more responsive customer experience.

Our expertise in using AI to drive measurable claims outcomes includes:

  • AI enablement: Automate and optimize the end-to-end claims lifecycle with an AI-powered operating model
  • Agentic workflows: Streamline claims handling, support decisions, and manage documentation and communications
  • Advanced data and AI: Deliver real-time insights to detect risk, improve accuracy, and reduce leakage
  • Composable digital core ecosystem: Enable rapid deployment, measurable return on investment (ROI), and continuous improvement through a modern, scalable architecture

How we can help

Many claims still require manual handoffs between claimants, providers, and adjusters, with limited visibility across systems. This slows cycle times, creates bottlenecks, and drives up inbound contact from customers chasing updates.

Solution: We connect claimants, providers, and insurers on a real-time, AI-enabled platform that reduces handoffs and improves visibility. Claims move faster through the process, with clearer communication at every step, reducing delays and improving customer and handler experience.

Routine tasks like data validation, document handling, and status updates often require manual effort across multiple systems. This increases handling time, Loss Adjustment Expenses (LAE), and limits adjuster capacity for complex claims.
 
Solution: We embed AI into claims workflows to automate repetitive tasks and streamline processing. AI handles data validation, documentation, and workflow progression, freeing up adjusters to focus on higher-value decisions. The result is faster processing, lower costs, and more consistent outcomes.

Adjusters often make decisions with incomplete or delayed information, particularly in complex or high-volume scenarios. This leads to inconsistent reserving, missed fraud signals, and increased leakage, impacting financial performance.

Solution: We use AI and advanced analytics to connect and analyze data in real time, providing a complete view of each claim. This enables more accurate reserving, earlier fraud detection, and improved recovery opportunities – helping reduce leakage and strengthen control over loss ratios.

Customers expect speed and transparency, while regulators demand auditability and data accuracy – and claims teams need to balance the two. But legacy systems make it difficult to adapt quickly, slowing innovation and increasing compliance risk.

Solution: We modernize the claims environment by connecting core systems with Insurtechs, data providers, and analytics services through a flexible digital ecosystem. This enables faster change, stronger compliance, and measurable ROI, while giving insurers the agility to respond to evolving market and regulatory demands.

AI-powered claims in practice

“Capgemini’s clients report up to 40% faster claims resolution, 5–12% savings in LAE, and 1–4% reduction in loss ratio.”

Here are some of our successful AI-claims implementations in practice.

Reducing manual effort and enabling touchless claims processing

Capgemini partnered with a leading US insurer to address fragmented legacy systems, high manual intervention, and inconsistent member experiences slowing claim resolution.

By embedding AI into claims workflows and integrating data across the ecosystem, the insurer achieved:

  • 70% touchless claims processing
  • 30% reduction in total cost of ownership
  • 25% increase in digital adoption

This significantly reduced manual effort while improving speed and customer experience.

Standardizing and automating claims across the lifecycle

Capgemini worked with a global multiline insurer facing fragmented processes and heavy manual handling across regions.

Through a global rollout of agentic AI, we helped the firm standardize claims processing across 12 countries, enabling straight-through settlement with minimal human intervention.

The transformation:

  • Cut average handling time to minutes
  • Delivered an eight-figure P&L impact
  • Improved consistency and reliability of outcomes

Fast-tracking storm and water damage claims

Capgemini supported a European insurer experiencing delays during high-volume weather events due to manual verification and fragmented workflows.

By applying AI to automate coverage validation, extract insights from unstructured data, and orchestrate workflows, the insurer achieved:

  • 95% processing accuracy
  • 84% correct claim outcomes

This improved responsiveness during peak events and strengthened operational resilience.

Get in touch with us today.

Ready to begin your journey towards AI-powered claims?

Contact us

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Meet our experts

Kiran-Boosam

Kiran Boosam

Global Portfolio Leader for Insurance
Kiran leads Capgemini’s Global Insurance Portfolio. A seasoned expert in P&C and life insurance, Kiran evaluates industry trends, forecasts insurance CXO strategies, develops tailored innovative portfolios, and enables our clients to leverage the strengths of the Capgemini group, external ecosystems, and emerging technologies.
Satish Weber

Satish Weber

Executive Vice President, Financial Services, Insurance Chief Sales Officer and FS Global Sustainability Lead
With over 25 years of experience in technology and business consulting within the Financial Services Industry, Satish is currently responsible for Capgemini’s capabilities to help clients set, achieve, and measure their ESG objectives and commitments to remain competitive and profitable in our ever-changing world.
andrew-hood

Andrew Hood

Executive Vice President, Global Insurance Practice Head, Capgemini Financial Services
Andrew Hood is a seasoned leader in insurance technology transformation, focusing on digital transformation, cloud migration and modernization of insurance platforms. He previously served as a Global Guidewire Practice Leader, overseeing more than 100 Guidewire projects across multiple continents. His team has developed accelerators and frameworks to streamline implementations and upgrades. His focus emphasizes reducing implementation timelines by leveraging AI for smarter migration strategies.

    FAQs about AI-powered insurance claims

    AI-powered insurance claims use Artificial Intelligence (AI) to automate claims processing, improve decision making, and deliver faster customer experiences.

    AI improves claims processing by automating routine tasks, analyzing data in real time, and helping insurers make faster, more accurate decisions.

    AI-powered claims management helps insurers reduce costs, improve operational efficiency, speed up claims resolution, and enhance customer satisfaction.

    Touchless claims processing uses automation and AI to handle claims with minimal manual intervention, reducing delays and improving accuracy.

    Capgemini helps insurers modernize claims operations with AI-powered workflows, predictive analytics, and scalable digital solutions.

    AI helps reduce claims leakage by identifying inconsistencies, detecting fraud risks, and improving claims accuracy through real-time insights.

    Insurers often face fragmented systems, rising operational costs, manual processes, and increasing customer expectations for faster claims experiences.