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Claims triage & adjudication

Claims intake triage, document handling, and adjudication routing - with the human review your team expects.

Claims management systemPolicy admin systemDocument storageEmail
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How the workflow runs

5 steps
  1. 1

    Intake

    Auto

    First-notice of loss arrives - classified, prioritized, and routed to the right adjuster

  2. 2

    Gather context

    Auto

    Policy details, prior claims, and supporting documents pulled into one view

  3. 3

    Fast-track check

    Auto

    Claims meeting clear criteria flagged for expedited processing

  4. 4

    Adjudication

    Human

    Adjuster reviews complex or high-value claims - a person decides, always

+ 1 more steps

4

Automated

1

Human review

4

Systems connected

The problem

Today this work is mostly manual. People move data between systems, chase approvals, and re-check things that should already be correct.

  • Claims piling up in first-notice intake with no triage - everything waits in the same queue
  • Adjusters pulling policy documents, prior claims, and supporting evidence by hand from three systems
  • Approvals chasing across email, the claims system, and a manager's inbox
  • Document review that is mostly routine but still needs a person to read every page - EOBs, police reports, medical records

What we automate

The workflow handles the repetitive parts inside the systems you already use. No new tools to learn, no data to re-key.

  • Triage at first-notice - classify the claim, prioritize it, and route it to the right adjuster or examiner
  • Pulling policy context, prior claims history, and relevant documents into one view
  • Flagging claims that meet clear criteria for fast-track processing
  • Routing approvals through the right chain based on claim type, amount, and line of business

Before and after

Before
  • Claims piling up in first-notice intake with no triage - everything waits in the same queue
  • Adjusters pulling policy documents, prior claims, and supporting evidence by hand from three systems
  • Approvals chasing across email, the claims system, and a manager's inbox
  • Document review that is mostly routine but still needs a person to read every page - EOBs, police reports, medical records
After
  • Claims triage and routing happen in minutes, not days
  • Adjusters spend their day on decisions, not chasing documents
  • Every action is traceable in your claims system for your team
  • Consistent routing - no claims lost in intake because nobody had time to sort them

Where humans stay in the loop

Automation handles the repetitive work. Your people handle the decisions that matter. The line is agreed and signed before launch.

  • Adjudication decisions on complex or high-value claims - a person decides, always
  • Document review where the stakes are high or the handwriting is unclear
  • Approval of any payment above the threshold your team sets
  • Edge cases and exceptions - routed to an adjuster with full context, not a blank queue