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InsuranceP&C Carrier

Automating Claims Processing for a Mid-Size P&C Carrier

End-to-end claims automation — from document intake and AI classification to intelligent routing and compliance logging — for a carrier processing 10,000+ claims monthly.

Mid-Market Property & Casualty Carrier

A regional property and casualty insurance carrier processing over 10,000 claims per month across personal and commercial lines. The claims team was drowning in manual document review, with a growing backlog threatening SLA compliance and customer satisfaction scores.

Manual review bottleneck threatening SLA compliance

Every claim required manual document classification, data entry, and routing. Adjusters spent more time on administrative tasks than on actual claim evaluation, leading to a 5-day average processing time that was pushing against regulatory SLA requirements.

Document classification errors led to misrouted claims, duplicate work, and compliance reporting gaps that required manual reconciliation at the end of each month.

5-day average processing time per claim

Manual document classification with high error rates

Adjusters spending 60% of time on administrative tasks

Monthly compliance reporting requiring manual reconciliation

Growing backlog threatening state SLA requirements

End-to-end claims automation pipeline

Module 01

Intelligent Document Intake

Automated document ingestion system that accepts claims submissions via email, web portal, and API. The system handles PDFs, images, scanned documents, and structured forms — extracting text via OCR and normalizing data into a consistent format for downstream processing.

Key Capabilities

Multi-channel intake (email, portal, API)
OCR for scanned documents and images
Automatic format normalization
Duplicate detection and deduplication
Module 02

AI-Powered Document Classification

Machine learning models trained on historical claims data to automatically classify incoming documents by type — first notice of loss, medical records, repair estimates, police reports, and supporting evidence. The system routes each document to the appropriate workflow stage.

Key Capabilities

95% classification accuracy across document types
Confidence scoring with human review escalation
Continuous learning from adjuster corrections
Multi-label classification for complex documents
Module 03

Data Extraction & Routing Engine

Structured data extraction from classified documents — pulling key fields like policy numbers, loss dates, damage descriptions, and claim amounts. The routing engine then assigns claims to the appropriate adjuster queue based on claim type, severity, and team capacity.

Key Capabilities

Key field extraction from unstructured documents
Smart routing based on claim type and severity
Adjuster workload balancing
Priority flagging for high-value claims
Module 04

Compliance & Audit Logging

Every action in the claims pipeline is logged with full audit trails for regulatory compliance. The system tracks document lineage, classification decisions, routing logic, and adjuster actions — generating compliance reports for state insurance department audits.

Key Capabilities

Complete audit trail for every claim
Regulatory compliance report generation
Document lineage and decision tracking
Configurable retention policies
Module 05

Claims Analytics Dashboard

Real-time dashboard showing claims volume, processing times, classification accuracy, and adjuster productivity. Managers get visibility into bottlenecks and can track SLA compliance across the entire claims operation.

Key Capabilities

Real-time claims volume and status tracking
Processing time analytics and SLA monitoring
Classification accuracy metrics
Adjuster productivity and workload views

From 5-day processing to same-day resolution

80%

Reduction in manual review

95%

Classification accuracy

5,000+

Documents processed monthly

3 wk

Delivery timeline

PythonFastAPIReactPostgreSQLAWSDockerOCRNLP

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