Insurance Claims Processing

Receives the first notice of loss via any channel (phone, web, app, email), extracts key claim data, validates the policy, and assigns a claim severity score for routing.

Verifies that the loss event is covered under the policy terms, checks exclusions, deductibles, and sub-limits, and confirms the insured's standing at the date of loss.

Analyses the claim against fraud indicators — claim history, social network links, inconsistencies in the loss narrative, and external fraud databases — to generate a fraud risk score.

For eligible claim types (motor, property), uses AI image analysis of submitted photos to estimate repair costs and validates against industry repair benchmarks.

Sets the initial case reserve based on the damage assessment, coverage limits, and actuarial benchmarks, and updates the reserve as new information emerges during the claim lifecycle.

Coordinates all investigation activities — loss adjuster appointments, medical assessments, police reports, and expert witnesses — tracking progress against SLA.

Calculates the settlement amount applying policy terms, deductibles, depreciation, and betterment, and generates a settlement offer letter for the claimant.

Processes the approved settlement payment, validates payee details against sanctions lists, and posts the payment in the financial system with the correct claims coding.

Analyses settled claims for subrogation and recovery opportunities, identifies liable third parties, and initiates the recovery process with supporting documentation.

Generates claims performance reports, loss ratio analysis, and regulatory returns (Solvency II, Lloyd's, state filings) from the claims data warehouse.