Claims read as they arrive, checked against the policy for missing documents and routed to the right adjuster, so a person decides every claim with the evidence in front of them.
See also AI Systems
Claims arrive by email, portal and post, in every format. The system reads each one as it lands, finds the policy in your claims system, and checks what is covered, what is excluded and which documents are still missing, the way your adjusters check it today.
Example request
Open every claim that arrived after hours. Check each one against the policy in Guidewire, list the documents still missing, and draft the first letter to the policyholder in our standard wording.
Each claim goes to the desk that owns it, by line, value and complexity, with the reason recorded. Anything outside your rules, a possible fraud indicator or a coverage question, goes straight to a person with the evidence attached.
Example request
Storm damage at the depot, claim 48213. Who should own it, what does the policy say about flood, and does anything in the claims history need a second look before we send the first letter?
Once the adjuster has the claim, the system keeps the file current: it logs every document as it arrives, chases what is still missing, and drafts each letter for the adjuster to approve. Nothing goes out without a person, and every step is logged against the claim.
Example request
Chase the repair estimate and the photos still missing on claim 48213, and draft the update to the policyholder. Hold it for my approval, and note on the file what we are still waiting for.
Tell us how this process runs today and we will scope it with you.
