For a head of claims, one thing matters: how long the path runs from notification to payout, and how many people have to touch it along the way. Every day of delay means a higher cost to serve and falling customer satisfaction, and every manual step is a place where a case can stall. Claims handling is now a process of data and decisions, not just paper, so its efficiency comes down to the software that runs it.
In our experience the hard part is not designing the intake form but tying the whole path into one measurable flow: from FNOL, through adjudication, to reconciling the payout with finance. We have no case study in this space to point you to, but we have something just as concrete: engineers who build process systems, integrations and the data layer, plus AI competencies inside the RITS Group. We strengthen the insurer’s team with the people who do this work.
Why is claims handling so painful?
Most delays come not from hard decisions but from context switching. An adjuster jumps between the policy system, an inbox, a spreadsheet and a repair-shop portal, retyping the same data several times. Information about a claim scatters across channels, and the manager cannot see in one place which case is breaching its SLA.
On top of that sit three pains that recur in every project:
- no single source of truth about a case, so the status depends on who you ask,
- rules kept in the heads of senior adjusters instead of in the system,
- manual reconciliation of payouts and recoveries that drifts away from the finance books.
Each one alone is survivable. Together they build a process that cannot scale without adding people.
What should digital claim notification (FNOL) look like?
Good FNOL takes work off the adjuster before they even open the case. Instead of a phone call and retyping, the customer or agent fills in a form or an app that validates the data and opens the case straight away. We design this moment so that as much as possible happens automatically, and a person steps in only where their judgement is needed.
In practice we build an intake channel that:
- guides the claimant step by step, adapting questions to the type of loss,
- validates the policy and coverage in real time, before the case enters a queue,
- opens the case automatically with a number, category and an initial priority,
- accepts attachments (photos, documents, recordings) and files them against the case.
That way the adjuster receives a complete case, not a raw notification to chase down.
What is a workflow and adjudication engine for claims?
The heart of the system is a process engine that knows what should happen at each stage. It drives the case through registration, assessment, decision and payout, enforcing rules and deadlines. The key is that business rules can be changed without rewriting code, because in claims they change often, following products and regulation.
Such an engine owns the stages and the transitions between them, the adjudication rules (what can be settled automatically and what needs a human), the approval thresholds and escalation paths, and the SLA measurement at every step. As a case nears a breach, the system escalates it on its own and surfaces it to the manager before an unhappy customer does. That shifts the team’s effort from policing the process to settling cases.
How do you use image recognition to assess damage?
This is where the AI layer comes in, but in a sensible role. Image recognition can pre-assess damage photos, flag inconsistencies and propose an estimate, speeding up the adjuster’s work. We treat it as a hint, not a verdict: the model suggests, and we leave the decision and the accountability with a person. That approach sits well with regulators and with operational common sense.
This is a competency we genuinely hold in the RITS Group, where we work with models, data and LLM and computer-vision solutions. We have no factory-floor claims deployment to recount, but we do have people who design and train such models and know how to wire their output into the process as a decision aid, not a black box.
How do you coordinate the repair and supplier network?
A claim rarely ends with a bank transfer. More often it needs coordination of repair shops, assessors and suppliers, each working in its own system. We join that network through APIs and a portal so that the order, the status and the settlement move between parties without emails and phone calls.
We usually build two things at once: integrations with partner systems where they have APIs, and a supplier portal for those who do not, so they can accept an order, add an estimate and photos, and confirm completion. For the adjuster that means one view of the repair status; for the director, comparable data on time and cost across the whole network.
How do you keep control of payouts and recoveries?
The last stretch, tracking payouts and recoveries, decides whether the process closes financially. This is where spreadsheets and manual matching do the most damage, because the payout lives in the claims system and the posting in the finance one. So we build reconciliation that matches one against the other and surfaces discrepancies before they grow.
In this layer we automate a register of payouts linked to the case and to the ledger, the running and monitoring of recoveries as a separate track with its own SLA, and reconciliation with the finance system with a difference report. The result is easy to measure: fewer manual corrections at month-end and a clear picture of how much we actually recover.
Which skills do we provide for a claims project?
We do not fill roles “just in case”, but against a specific slice of the process. For a claims project we usually assemble:
- a solution architect who ties process, data and integrations into one architecture,
- backend developers building the workflow engine, the rules and the APIs,
- integration specialists connecting the policy system, finance and the supplier network,
- AI/Data engineers (a RITS Group competency) when image recognition or analytics is in play.
That mix lets a team take ownership of the whole path, not a single screen, and grow the system in stages.
How do we do it at RITS?
We work as a nearshore partner from Poland that adds skills exactly where the insurer’s team lacks them. Even if we cannot show a claims case study, we provide people experienced in process systems, integrations and the data layer, and through the RITS Group also AI, LLM and computer-vision competencies. We verify skills before the start and shape the team around the project, not around who happens to be free.
Most often we do this as custom software built by our team and, where gaps need filling fast, as team augmentation. We covered the differences between these approaches in our article on IT engagement models.
Where to start with streamlining claims handling?
Start from the single most painful stretch, usually FNOL or payout reconciliation, and measure how long it takes today and where the case waits. That defines the scope of the first phase, the integrations you need and the roles to fill. It is better to close one stretch end to end than to replace everything at once.
Streamlining your claims handling? Let’s talk - we’ll match a team and an architecture to your claims process.