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Faster claims intake and triage—without losing control.

Ingest, classify, extract, and summarize claim documents—then recommend next steps for adjuster approval.

Book a discovery callSee example engagements

The problem

  • Claims processing takes 15–30 days due to manual document review
  • Inconsistent adjuster decisions across similar claims
  • High cost per claim due to manual labor intensity
  • No structured way to surface comparable claims or prior decisions

How it works

1

Ingest Claim Docs

Receive claim submissions—normalize formats and tag metadata.

2

Classify

Identify claim type, line of business, and complexity tier.

3

Extract

Pull structured fields from unstructured documents.

4

Summarize

Generate a concise claim summary with key facts and evidence citations.

5

Recommend Next Step

Surface a recommended action with confidence score and comparable claims.

6

Human Approval

Adjuster reviews recommendation, edits if needed, and approves.

7

Update Systems & Log

Push decision to claims management system and log every action.

Deliverables bundle

Adjuster copilot UI with claim summary + recommendation
Rules engine + exception handling logic
Eval harness (extraction accuracy, recommendation quality, bias checks)
Integration plan for claims management system

Integrations

GuidewireDuck CreekSalesforceMicrosoft 365ServiceNow

Controls included

  • PII/PCI data protection
  • Explainable AI for recommendations
  • Human approval for settlements above threshold
  • Bias monitoring in claims decisions
  • Audit trail for claims processing

Pilot plan

Discovery(2 weeks)

Analyze claims workflows, document types, and system integrations.

Build(5 weeks)

Document extraction, summarization, recommendation engine, and adjuster UI.

Validate(2 weeks)

Parallel run with adjusters, accuracy measurement, and feedback incorporation.

Go-Live(1 week)

Controlled production deployment with monitoring and adjuster training.

Expected outcomes

All figures are estimates based on comparable engagements

  • 15–30% reduction in adjuster handling time per claim (estimate)
  • Reduced cycle time for routine claims (estimate)
  • Improved decision consistency across adjusters
  • Comprehensive audit trail for processed claims

Risks & mitigations

Risk: Model bias in claims recommendations

Mitigation: Bias testing across demographics; ongoing fairness monitoring; human review for edge cases.

Risk: Incorrect extraction or summarization

Mitigation: All summaries cite source documents; eval harness tracks accuracy continuously.

Risk: Adjuster trust and adoption

Mitigation: Phased rollout starting with recommendation-only mode; adjusters retain full override authority.

Frequently asked questions

Want to talk through your use case?

Book a 30-minute discovery call. We'll scope the workflow, map integrations, and outline security controls—no commitment required.

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