Claims Processing Automation Suite
InsureTech
End-to-end AI claims pipeline that auto-adjudicates simple claims — boosting throughput by 3x.
Overview
Project Overview
InsureTech processes 120,000+ insurance claims monthly across property, auto, and liability lines. Their legacy system relied on manual document intake, sequential adjuster review, and paper-based approvals — creating 21-day average cycle times and frustrated policyholders.
Agiliztech implemented an end-to-end AI claims pipeline that ingests documents, validates coverage, assesses damage estimates, and auto-adjudicates simple claims — boosting throughput by 3x while reducing cycle time by 75%.
Industry
Insurance
Timeline
16 weeks
Tech Stack
The Challenge
What problems needed solving?
Manual Document Intake
Claims arrived via mail, email, fax, and portal in inconsistent formats — requiring manual sorting, scanning, and data entry for every claim.
Sequential Processing Model
Each claim passed through 5-7 sequential review stages, with handoff delays adding 3-5 days to every claim regardless of complexity.
Adjuster Capacity Constraints
A team of 85 adjusters was overloaded with both simple and complex claims, spending 60% of time on straightforward cases that could be automated.
Fraud Detection Gaps
Manual review caught only 2.1% of fraudulent claims, with most fraud discovered during post-payment audits — after funds were already disbursed.
The Solution
How Agiliztech delivered results
Omnichannel Document Ingestion
Built an intake system that accepts claims from any channel, automatically extracts structured data, and creates a unified digital claim file in seconds.
Parallel Processing Pipeline
Redesigned the workflow as a parallel pipeline where coverage verification, damage assessment, and fraud screening happen simultaneously rather than sequentially.
Auto-Adjudication Engine
Developed an ML-powered decision engine that auto-approves straightforward claims meeting predefined criteria — handling 62% of total volume without human touch.
Real-Time Fraud Detection
Implemented a multi-signal fraud model that analyzes claim patterns, claimant history, and document anomalies to flag suspicious claims before payment.
The Benefits
Measurable business impact
3x
Throughput
Increase in monthly claims processed without additional adjuster headcount.
75%
Cycle Time
Reduction in average claim cycle time — from 21 days to just 5.2 days.
62%
Auto-Adjudication
Of claims now fully auto-adjudicated, freeing adjusters for complex cases.
8.4%
Fraud Detection
Catch rate for fraudulent claims — up from 2.1% — saving $4.2M annually.
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