InsurTech EIP, an embedded insurance provider, has unveiled Virtual TPAi, an AI-powered tool designed to deliver end-to-end automation of insurance claims processing and decision-making.
The product centres on a proprietary voice-led AI agent that replicates the function of a third-party administrator (TPA), handling real-time, human-like conversations with customers to answer policy queries and submit claims on their behalf.
The agent is capable of managing up to 20 simultaneous conversations around the clock, representing the equivalent output of roughly 90 human agents, significantly cutting insurers' dependence on and expenditure related to traditional TPA services. It is able to operate in any language.
Once a claim is submitted, the information gathered by the agent is passed to EIP's backend rules engine, which renders an automated decision, either approving the claim outright or routing it to a human handler for further review.
The rules engine operates on approximately 80 configurable switches that insurers set themselves in line with their policy terms, providing full transparency and auditability of every decision made. Unlike probabilistic AI models where the reasoning behind outcomes can be difficult to scrutinise, EIP's approach removes those opacity concerns entirely.
The engine has underpinned EIP's automated claims decisioning for over a decade, and has now been modernised with the AI agent layered on top to create a fully integrated, front-to-back solution.
EIP CEO Ross Sinclair said, 'After almost a year in development, we are delighted to be launching our Virtual TPAi to support insurers and retailers to leverage the efficiencies that AI has to offer in a compliant way. The AI automation frees up human agents' time so that they can focus on the more complex claims that require their attention.
'The growth potential is huge here because we've done the hard work of making sure it works in a regulated environment. We are proud to continue leading the charge on the insurance industry's adoption of AI in a way that is responsible and human-led, and we look forward to continuing to support clients to transform their operations with our cutting-edge tools.'
EIP director of product David Michell Dawson said, 'What we were building had to be at least as good as, if not better, than the best customer experience already available today. It needed to reflect the communication channels that customers are comfortable with, which heavily influenced our decision to invest significantly more time and money in the complex process of making the Virtual TPAi voice led. The sophisticated technology behind it makes it impossible for the AI agent to move outside the guardrails we have imposed.'