Claims automated end-to-end for property & casualty.
The carrier had strong digital intake but manual decisioning across triage, fraud review, and settlement. We rebuilt claims operations around process mining, orchestration, and human-in-the-loop controls so straight-through processing could scale without increasing leakage.
The situation we walked into.
Digital claim submission was already live, but the real work still happened in swivel-chair handoffs between adjusters, document teams, and payment operations. As claim volumes rose, cycle times stretched and customer sentiment deteriorated.
The client wanted automation without creating a black box. Any new model had to be auditable, easy to override, and explicitly tuned for complex weather, liability, and fraud scenarios.
A simplified view of the delivery shape, the control points that mattered, and the signals the client team used to keep the program on track.
The changes that made the outcome possible.
Process mining
We traced every manual touch, exception route, and rework pattern across home, auto, and commercial lines.
Decision orchestration
Rules, models, and document services were wrapped in a single claims workflow with visible checkpoints.
Human-in-the-loop controls
Adjusters could intervene on confidence thresholds, special handling flags, and suspicious claim combinations.
Operations transition
The operations team moved to exception management, model tuning, and proactive outreach instead of queue clearing.
How the delivery moved from pilot to scaled operation.
Claims baseline
The carrier gained a fact base on the real sources of delay, leakage, and avoidable rework.
Automation spine live
Low-complexity claims began routing through rules and document services with human checkpoints.
Fraud and exception tuning
Confidence thresholds and specialist routing were calibrated using live claim outcomes.
National rollout
The new workflow expanded across lines of business with service-level dashboards and QA feedback loops.
What changed after the transformation settled into the run.
Customers stopped chasing status
Most policyholders received a decision path and expected settlement timing within the same business day.
Adjusters focused on the right work
Specialists spent more time on complex disputes and less time on routine triage or documentation gaps.
Controls improved while the process sped up
Every automated decision remained explainable to auditors, regulators, and claims leadership.
We didn't want a claims robot. We wanted a process that made our best people available for the claims that really need them.Chief Claims Officer - Top-10 insurer