Insurance Claims Processor

A mid-size insurer processing 200+ claims daily faces a bottleneck that compounds during storm seasons. Each claim requires extracting data from photos, PDFs, and handwritten forms, then cross-referencing policy details and running fraud checks before routing to the right adjuster. Adjusters spend roughly 70% of their day on document intake rather than assessment work.

The industry is under pressure from regulators mandating faster turnaround and policyholders expecting digital-first experiences. Incumbents rely on legacy claims management systems never designed for unstructured document intake. Manual data entry introduces error rates averaging 5-8%, and fraud detection depends on individual adjuster experience rather than pattern analysis across the full claims corpus.

Tractable has demonstrated that computer vision can assess vehicle and property damage from photos. Shift Technology uses ML to flag suspicious claim patterns. The question is no longer whether AI works for claims — it is how fast a carrier can integrate these capabilities without a multi-year platform migration.

This agent ingests claim documents from any channel — email attachments, portal uploads, fax scans, mobile photos — and runs layout-aware extraction using transformer-based document understanding models (LayoutLM architecture) to pull policy numbers, claimant details, incident dates, damage descriptions, and supporting evidence without per-template configuration.

It cross-references your policy administration system in real time, verifying coverage terms, deductibles, and exclusions. Simultaneously, it runs anomaly scoring against your historical claims data using gradient-boosted models trained on your own loss history, surfacing claims that match known fraud typologies — staged accidents, inflated repair estimates, phantom claimants.

The agent integrates via API with Guidewire ClaimCenter, Duck Creek, and Majesco. Clean claims are auto-routed to the appropriate adjuster queue with a structured summary: what was claimed, what the policy covers, and any flags. Adjusters open a claim and see structured data ready for a decision.