Automate Claims Processing

What Automated Claims Processing Covers?

The use of AI and intelligent document processing (IDP) to handle the document-intensive tasks across the insurance claims lifecycle, from first notice of loss through settlement, with minimal manual intervention.

Claims workflows involve high volumes of diverse, unstructured documents, including:

• FNOL forms
• Police reports
• Medical records
• Repair estimates
• ACORD forms
• Explanation of benefits (EOB) statements

How the process works

Automated claims processing handles each stage of the claim's lifecycle through a connected sequence of steps:

• Document capture: ingests documents from multiple intake channels.
• Document Classification: identifies and sorts each document by type.
• Data extraction: pulls relevant data fields from each document.
• Validation: checks extracted information against policy records and business rules.
• Fraud detection: identifies anomalies that may indicate fraudulent activity.
• Routing: directs cases to settlement or escalation based on outcomes.

Primary business outcomes

Organizations that implement automated claims processing can expect measurable improvements across four key areas:

• Faster claims cycle times
• Lower cost per claim
• Improved fraud detection rates
• Higher straight-through processing (STP) rates for routine claims