Claims Processing Automation Reducing Time-to-Decision by 65%

The challenge

Claims handlers were manually extracting information from claim forms, cross-referencing policy documents, and preparing recommendations for underwriters. The process took 3–5 days per claim and was creating a backlog that impacted customer satisfaction scores.

Our solution

We built an end-to-end claims intake and triage automation using document AI for extraction, a rules engine for initial assessment, and a workflow tool for routing complex cases to the appropriate handler with a pre-populated case file.

The Problem

Insurance claims processing is document-heavy by nature. Each claim arrives with a form, supporting photos or documents, and a reference to a policy. A handler must read all of it, understand what's covered, and make a recommendation. At 500 claims per month, the volume was creating a 3–5 day queue — unacceptable for customers who'd just experienced a loss event.

Our Approach

We worked with the claims team for a week to understand their triage logic: what makes a claim straightforward vs. complex? We discovered that 40% of claims matched clear patterns where the coverage question was simple and the amount was within a threshold — these could be fully automated.

The remaining 60% still benefited from automation: document extraction, policy cross-referencing, and a pre-populated case file meant handlers could focus on the judgment call rather than the admin.

The Outcome

Within 6 weeks, the entire backlog had been cleared. Straightforward claims were being resolved within 4 hours of receipt. The claims team described the tool as transformative: they were no longer buried in paperwork but focusing on complex cases that genuinely required their expertise and customer empathy.

The broker subsequently expanded the automation to their commercial lines claims team, achieving similar results.