AI reads incoming claim notifications (email, web form, FNOL portals), extracts policyholder details, incident description, date of loss, and initial liability estimate. Creates claim record in your system with pre-populated fields. Duplicate detection and fraud flag scoring.
AI reads and extracts structured data from loss adjuster reports, medical reports, repair estimates, invoices, legal correspondence, and police reports. Populates claim reserves, coverage notes, and subrogation flags automatically.
Automates policy data entry from broker submissions (CSV, PDF, ACORD XML), endorsement processing, renewal data prep, and document indexing into your policy admin system. Handles Guidewire PolicyCenter and Duck Creek Policy via API.
AI reads consultant referral letters and procedure request forms, verifies against PMI policy terms, checks evidence of cover, and generates authorisation decision with clinical codes — for private medical insurers and self-insured employer PMI schemes.
AI cross-references claim data against historical patterns: duplicate claimant details, address clustering, device fingerprints (for web claims), and temporal anomalies. Flags cases for Special Investigations Unit (SIU) without making autonomous decisions.
AI decisions are explainable and auditable: every automated decision records the data it used and the rule it applied. Designed for FCA Consumer Duty requirements, ICO UK GDPR data minimisation, and PRA-mandated audit trail standards.