P&C and health claims operations often report strong First Contact Resolution while structural margin leaks through repeat contacts, adjuster escalation bounces, and dispatch revisits that never surface in standard dashboards. Now AI agents are fielding those same interactions at machine speed — and we independently verify whether they actually lowered the true cost of a resolved claim, or just closed the file faster.
Adjusters close claims as resolved, but 15-25% generate a second site visit within 14 days. Each revisit costs $180-$400 in direct dispatch expense plus the hidden cost of reprocessing the claim.
Policyholders call back within 7 days for status, supplementals, or unresolved coverage questions. These repeats are logged as new contacts, hiding the true resolution cost.
Claims escalated to senior adjusters or desk supervisors and bounced back without resolution. Each bounce averages $22-40 in handling cost and 2-3 days of cycle time.
Three of 16 fault lines the verdict grades. See the full method →
Did the AI work?
Would not hold
A claim like this would close as “resolved” — then generate a second field visit 11 days later.
True cost to resolve
~$190
reported: $52
Fault attribution
Data
✓
Model
✓
Operator
✗
Handoff
✗
On a failure like this, fault would land on the operator workflow and the field-dispatch handoff — correct inputs, sound model call, dropped on the revisit. Not the adjuster’s judgment.
Figures are illustrative and conditional. On your engagement they’re produced from your de-identified data and labeled accordingly.
Anonymized CSV exports from your claims management and telephony systems. No API integration is required for the initial read; security review can be scoped as needed.
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