Role
Claims adjuster
How many times do you ask a client to complete the same claim? The first request always goes out within the statutory deadline - what lengthens a claim is the second and the third, after the first went out before you knew what would really be needed.
Intro call
Four questions we would start with
How many times do you go back to the client for further documents?
The request for missing items goes out on time, but if it is incomplete the claim lengthens by a full round of correspondence - and that is the moment the client starts being unhappy.
How many people touch one claim from notification to payment?
Usually four or five, and each reads the same documentation afresh.
What do you do when the client's account and the documentation say different things?
Whether the discrepancy is caught before the assessment, or surfaces at an appeal.
When is the amount of the benefit decided?
And whether similar claims in similar circumstances are settled similarly - or whether it depends on the adjuster.
We take over the assembling and the comparing, you keep the decision on the benefit
Taking in notifications, assembling the documentation, bringing the data together and preparing the valuation can be taken off the desk. The decision to accept and the amount of the benefit stay with the adjuster.
- The request for missing items is complete the first time. - The list required for that type of claim comes from a register rather than from the memory of an adjuster handling forty claims today.
- The claim arrives assembled. - The policy, the cover, the claims history and the documents in one view, instead of four systems.
- Similar claims are pointed out. - The adjuster can see how similar claims were settled - which increases consistency without taking the decision away.
Scope
What can be taken off claims handling
Twenty example tasks. Each one has a human approval point. Below is a selection, and the scope we fit to your products.
Taking in a claim
- One notification route from several channels
- Pulling the event details out of the notification
- Linking the notification to the policy and the cover
- A signal when a notification falls outside the period of cover (assessment: the adjuster)
- Acknowledgement with the list of documents required
Assembling the documentation
- The list of documents required for the type of claim
- Pointing out the gaps immediately after notification
- A reminder to the client about the documents named in the request
- Reading the data out of the documents sent in (verification: the adjuster)
Assessment and valuation
- The facts from the notification and the documentation brought together
- Pointing out discrepancies between the sources
- Comparison material from similar claims
- An initial calculation at the agreed rates (assessment: the adjuster)
Decision and payment
- A draft of the reasons for the decision (content and decision: the adjuster)
- Checking the decision against the scope of the policy
- Preparing the documents for payment
- Telling the client what stage the claim is at
Appeals and recovery
- The claim brought together for an appeal with its full history
- Pointing out claims with possible recovery (assessment: the adjuster)
- Appeals summarised by cause
A day's work
Today
- You assemble the documentation in stages, discovering gaps one by one
- You check the policy and the cover in a separate system
- You retype the data from the documents by hand
- You do not know how similar claims were settled last quarter
- The client calls because they do not know what stage the claim is at
- At an appeal you reconstruct the claim's history from the file
With AI assistance
- The full set of required documents is known at the first request
- The policy, the cover and the claims history sit with the claim
- The data from the documents is read out, you verify it
- Similar claims are pointed out as comparison material
- The client is told the stage without calling
- At an appeal the claim's history is already assembled
- Time to settle
fewer claims lengthened by a second request
the list of required documents follows from the type of claim
- Accuracy of valuation
fewer gaps between the valuation and reality
comparison material is available at the assessment
- Share of appeals
fewer appeals caused by a decision nobody understood
the reasons rest on the facts gathered
- Consistent decisions
similar claims are settled similarly
the adjuster can see how it was decided before
We start with complete documentation, because that is where the most days are lost.
- Step 1
The document list and the gaps
The requirements by type of claim, the full set identified before the request goes out.
- Step 2
The claim assembled in one view
The policy, the cover, the history, the documents.
- Step 3
Reading the documents and bringing the facts together
Data from the documents verified by the adjuster, discrepancies pointed out.
- Step 4
Comparison material and appeals
Similar claims and the history at an appeal. Last, because it needs the claims to be in order.
Common questions
Questions that come up at the first meeting
What about small claims where handling costs more than the payout?
That is usually the best area to start with, because there the handling is the largest part of the cost rather than the payout. Even with the decision kept with a person, shortening the road to it gives the largest effect on those claims.
Will claims handling need fewer people?
The decision to accept and the amount of the benefit stay with the adjuster and must stay there - we say so plainly below. We take over assembling the documentation and identifying the policy details, which is what takes up most of a claim's time today. With a rising number of claims that usually means the same team keeps up, not that it is smaller.
Does this fall under the AI Act?
Handling property claims is not named expressly as a high-risk use - unlike risk assessment and pricing in life and health insurance for individuals. The area is close to the line, though, so we hold to the rule: the decision about the benefit belongs to a person, and the client has the right to know the reasons for it.
Still have a question that is not here? Book a call
Next step
How many of your claims need a second request for missing items?
We will show you what claims handling looks like when the request for missing items is complete the first time and the claim reaches the adjuster assembled.