A mid-size DACH insurer processes thousands of claims per month. Each claim arrives as a mix of emails, PDFs, scanned documents, and phone call notes — in German, English, or both. The claims team triages manually: open the email, read the attachments, classify the claim type, extract the relevant data, check policy coverage, route to the right adjuster. For straightforward claims — the ones that follow clear patterns — this manual triage takes 15–30 minutes per case. Multiply by hundreds of cases per day, and the team spends 70% of its time on work that follows the same decision logic every time. The result: backlogs, delayed settlements, frustrated policyholders, and adjusters who spend their day on data entry instead of the complex cases where their judgment actually matters.
Agents extract claim data from any input format — email, PDF, scanned document, portal submission. Policy number, claim type, incident details, and supporting documents are structured into a standard format regardless of how they arrived.
Based on claim type, value, complexity indicators, and policy terms, the agent routes each claim: straight-through processing for simple cases, adjuster queue with pre-filled context for complex ones. Triage rules reflect your actual guidelines, not generic automation.
Agents cross-reference claim details against policy terms, checking coverage limits, deductibles, exclusions, and special conditions. Discrepancies are flagged before an adjuster touches the case.
For claims that need human review, the agent prepares a structured assessment package: extracted data, coverage analysis, comparable claim history, and a preliminary assessment based on your guidelines. The adjuster reviews and decides — they don't build the case from scratch.
25 min → 2 min per case
Automated the intake-to-triage pipeline for a motor claims team processing 500+ claims per month.
Extracts claim details from email body and PDF attachments (police reports, repair estimates, photos)
Identifies claim type (motor, property damage, third-party liability) and maps to correct workflow
Matches to policy record and verifies coverage, limits, and deductibles
Structures all data into the claims management system with document classification
Routes to straight-through processing (standard) or adjuster queue (complex) with pre-built case file
We'll tell you where the friction is, what should stay human, and whether automation is worth doing.