From FNOL to adjuster sign-off,
one pass through the pipeline.
This page replays the claims-triage pattern from our insurance track. Documents come in, a decision packet comes out, and anything that needs judgment lands in a person's queue with the evidence attached. Claim values and confidence scores below are representative; the pipeline shape is what we ship.
A simulated pipeline run processes claim CLM-20418, an auto collision claim. It passes intake, extraction, policy check, and rules, then routes to the straight-through queue with the payout pending adjuster sign-off. Five more claims are then triaged in the queue below.
Six claims in. Three routes out.
Low-risk, in-coverage claims go straight through with the payout queued for sign-off. Anything ambiguous goes to an adjuster. Anything that trips a fraud signal goes to SIU with the evidence attached. Nothing pays out without a person's name on it.
Routing thresholds here are illustrative. In an engagement they are set with your claims lead and proven against an eval set you own.
Documents and rules are automated. Judgment is routed.
Document extraction
FNOL emails, photos, police reports, and policy files become structured fields with per-field confidence. Low-confidence fields are queued for human correction, and the corrections feed the eval set.
Rules + retrieval
Coverage, deductibles, and sublimits are checked against the policy file itself, retrieved and cited. Straight-through criteria are explicit rules your claims lead can read and change.
Approval gates + audit
Every payout clears an adjuster. Every decision writes a packet: inputs, retrieved documents, rule results, and who approved it. The log is built for regulators, reinsurers, and your own postmortems.
Run this on your claims.
Tell us your book of business, your TPA spend, and the cycle-time number that would prove this works. We respond in two business days with a scoped proposal.