Claims Triage Automation for InsurTech

Overview

Problem

Claims arrived from multiple channels with inconsistent data quality and no clear prioritization.

Solution

• Created a triage model combining policy risk, claimant history, and incident metadata
• Built an explainability panel for adjusters to understand model decisions
• Integrated with the existing claims workflow and SLA queueing rules

Outcome

• 33% faster claim assignment
• 22% lower leakage on high-risk claims
• 97% SLA compliance for first-touch review

“We now route complex claims to the right adjusters in minutes, not days.”