Think of it as a smart digital claims clerk that reads all the forms, emails, photos, and reports, then does most of the claim processing work automatically so humans only handle the tricky edge cases.
Traditional insurance claims processing is slow, labor-intensive, and error-prone because adjusters must manually read documents, validate information, and make decisions. Claims automation uses AI to ingest and understand claim data, route and decide simple cases automatically, and surface only complex claims to humans—reducing cycle time, cost per claim, and leakage.
Deep integration into insurer core systems and workflows (policy admin, FNOL, claims management) plus proprietary historical claims data used to tune models and rules makes the solution sticky and hard to replicate quickly.
Hybrid
Vector Search
Medium (Integration logic)
Context window and inference cost for processing large, unstructured claim files and attachments at high volume; plus integration complexity with legacy core insurance systems.
Early Majority
This framing emphasizes language-model-driven understanding of claim documents (unstructured text) as a core enabler, going beyond simple rules engines and RPA that only automate structured, repeatable steps.