Reduce manual preparation
Collect evidence and policy context in a consistent review file.
Claims Processing Automation
Help adjusters focus on claims that need judgement.
Prepare claim information from forms and supporting evidence, check defined coverage rules and prioritise cases for review. Straightforward administrative steps can be automated where permitted; claim decisions and fraud allegations remain subject to appropriate professional oversight.
Potential business benefits
Make complex cases easier to review
Prioritise missing information and policy exceptions.
Improve auditability
Record extracted evidence, rule outcomes and human decisions.
Illustrative impact - example only
Reduce manual preparation
- Claims per month
- 700
- Administratively straightforward claims
- 50%
- Straightforward claims that meet assisted-processing rules
- 60%
Illustrative calculation 700 x 50% x 60% = 210
In this hypothetical month, 210 cases might enter an assisted flow. This is not 210 automated payouts.
Illustrative scenario, not a measured client result or guarantee. Actual outcomes depend on scope, data, controls and adoption.
What we would measure
Make complex cases easier to review
- Adjuster review time
- Rework rates
- Cases returned for missing information
Measurement approach only - not a measured client result or guarantee. Measures and baseline are agreed with you during discovery.
What we would measure
Improve auditability
- Completeness of the claim file
- Overrides and disputed decisions
- No fixed fraud-detection improvement is claimed
Measurement approach only - not a measured client result or guarantee. Measures and baseline are agreed with you during discovery.
Typical applications
- Take in claims in several formats
- Classify supporting evidence
- Retrieve policy terms
- Prepare coverage checks
- Triage exceptions and hand off to adjusters with reasons
Potential extensions, scoped separately
- Anomaly indicators for adjuster review
- Payout calculation support for adjuster approval
How it works
-
Receive claim
Take in the claim and its documents.
-
Check coverage context
Extract details and check policy terms.
-
Flag gaps and anomalies
Highlight missing data and exceptions.
-
Adjuster review
An adjuster decides, or the permitted workflow continues.
Designed to work within your controls
Integration & permissions
Explicit data-protection controls and role-based access to claim data.
Professional oversight
Eligibility, denial and fraud decisions stay with qualified people.
Monitoring & handover
Each result shows what was checked and its source.
Bring one claims journey and its review steps.
We can identify where assisted processing is appropriate. In a 30-minute discussion we look at how it could work in your environment.
