Claims That Process Themselves
a mid-market property and casualty insurer
faster claims processing
of routine claims straight-through
claimant NPS improvement
Routine claims sat in queues for days while adjusters retyped information from photos, PDFs, and emails into the claims platform. Cycle times drove complaints and policyholder churn, yet most claims were straightforward and followed the same steps every time. Leadership wanted the routine work automated end to end while keeping adjusters in control of anything unusual.
How we approached it
Analyzed a year of closed claims to separate straight-through candidates from cases that genuinely needed adjuster judgment.
Deployed document intelligence models to extract structured data from claim forms, damage photos, estimates, and correspondence.
Built agents that assemble the claim file, verify coverage against the policy, flag fraud indicators, and draft settlement recommendations.
Kept adjusters as the approval step on every payout, expanding automation limits only as accuracy held across each claim category.
“Simple claims that took a week now close in a day, and my adjusters finally spend their time on the complex losses where they add real value.”
No. Agents assemble the file, verify coverage, and draft a recommendation, but an adjuster approves every settlement, with automation limits expanded gradually as accuracy proved out.
Every claim is scored against fraud indicators drawn from the insurer's historical cases, and anything suspicious routes to the special investigations team instead of the fast path.
Complex losses, disputed liability, injury claims, and anything the models flag as unusual bypass automation entirely and land with an adjuster carrying full context.
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