First notice of loss on WhatsApp, photo triage and network-hospital matching turned a multi-day cashless approval into a same-visit outcome, with the whole trail auditable.
For a family at a hospital admission, the cashless pre-authorisation wait is the most stressful part of the policy they bought. For the insurer, it is a queue of half-complete forms, missing documents and back-and-forth that stretches a decision across days.
The bottleneck was rarely the underwriting rule. It was capture: getting a clean first notice of loss, the right documents, and a verified network hospital, without a dozen phone calls.
Agentic Universe captured first notice of loss on WhatsApp and voice. The agent guided the customer through photo capture with on-the-spot triage, matched the admission to a network hospital, and checked the request against the customer's cover before anything reached a human.
A clean, verified pre-authorisation package arrived at the desk instead of a raw enquiry.
The agent is grounded on the insurer's policy and network data. It verifies against the customer's own cover, flags exclusions early, and hands off low-confidence or high-value cases to a claims officer with the context already assembled. Customer and hospital are notified by SMS at each step.
Every document, message and decision is logged and searchable. The medical and compliance teams sign off on high-stakes cases, and the agent never approves outside policy. Auditability is built in, so a case can be reconstructed end to end at any time.
The insurer cut days off the cashless approval turnaround, reduced document-chase loops, and gave hospitals and families a same-visit experience on straightforward cases, while officers focused their time on the cases that genuinely needed a human.
In health insurance, speed at the moment of admission is the product experience. Agentic AI that captures, verifies and finishes the routine work, and escalates the rest with full context, turns the cashless promise into something customers actually feel.
Deployed under NDA and anonymised at the customer's request. Named references available in your segment on request.
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