AI for claims triage and straight through processing

Allianz Partners' director of partnerships told a US travel advisor consortium in April 2026 that AI assistance now handles 65 to 70% of all its claims. She said this has cut claims turnaround time from about 14 days, the average for the consortium's member agencies, to three to four days, with some claims turned around in a matter of hours.

NN Group's Dutch non life insurance business, Nationale-Nederlanden, built its own AI solution that automates steps such as flagging the cause of damage and checking policy cover for high volume, low complexity claims like household damage and a broken car windscreen. Claims that fall outside the predefined criteria or show an unusual pattern are flagged automatically for a human claims handler, so complex or potentially fraudulent claims are still assessed by people.

In its 2025 annual report to shareholders, Travelers says it launched a natural language generative AI voice agent that takes first notice of loss by phone, used first for auto damage claims and planned to expand to more lines of business and claim interactions. The same letter reports that more than half of all claims are eligible for straight through digital processing, which customers choose about two thirds of the time, and that another 15% of claims are handled with advanced digital tools. No outcome figures for the voice agent itself were published; the company describes early adoption and feedback as positive.

Lemonade's claims bot AI Jim takes the first notice of loss in a chat with the customer, pays or declines simple claims within seconds and assigns the claims it may not settle, or has concerns about, to human claims experts based on their specialty, workload and schedule. A separate system, Forensic Graph, uses machine learning to predict, detect and block fraud across the customer engagement. The annual report states that AI Jim took the first notice of loss without human intervention 96% of the time and that roughly 55% of claims were automated from start to finish, both as of December 31, 2025.

Sedgwick, a global claims administrator, integrated Sidekick Agent into the workflows and screens of its own claims management systems. Built on Azure OpenAI Service and Azure AI Document Intelligence, it gives examiners claim insights, the day's top priorities, forecasts of anticipated claim trajectories, analytics on claim durations and reserves, and guidance on the next steps in the claim life cycle, and supports quality assurance for consistency and compliance. It follows an earlier version of Sidekick built on ChatGPT technology. No outcome figures were published.

ZhongAn Insurance published its 2025 claims service annual report, describing how it built AI into the whole claims chain. In health insurance, more than 45% of claims are reviewed and closed automatically. In motor insurance, the "ZhongAn Auto Insurance" mini program combines an NFC emergency service, video claims review and "motor insurance AI damage assessment", which together cut the time to settle claims under 10,000 yuan to as little as 13.3 minutes, with damage assessment taking as little as 116 seconds. The company also uses large and smaller specialised models to automate image diagnosis, liability decisions and medical record extraction in pet and accident insurance, and AI image recognition, voice analysis and automated review against organised insurance fraud.

MAG Seguros, the Brazilian insurance business of the Aegon Group, runs BenLev, an AI enabled platform introduced in 2023 that checks claim documents, validates information and moves each claim through the steps required for automatic settlement, work that previously needed several manual reviews. Aegon's newsroom reports that MAG has reduced payout times for its pension related products to eight days.

Hiscox is rolling out Microsoft 365 Copilot to its more than 3,000 employees after a trial. A senior technical claims underwriter in the UK claims team uses it to identify and record the key information of a new claim, to summarise long expert medical evidence and legal advice, and to pull the progress of a claim from several emails and compose an update to a broker or customer. He says that recording a new claim now takes him as little as 10 minutes instead of up to an hour. This is one user's experience, not a measured program result.

Tokio Marine & Nichido Fire Insurance uses Shift Technology's claims intake and claims fraud detection solutions, extended with generative AI that extracts data from structured and unstructured sources such as images and documents. The system highlights the points handlers should check for consistency across estimates, damage photos and claim statements, which makes reviews more efficient and more standardized, including during the surge of claims after large disasters, and it helps detect suspicious claims, which tend to rise after such events. No figures were published.

Admiral Seguros, the Spanish business of Admiral Group, sends motor claimants a link to a web app in which they photograph the damage, and Tractable's AI produces the repair estimate within minutes. Tractable reports that Admiral Seguros processed 12,000 touchless claims this way in 2021, that 90% of claim estimates were processed without human appraisers and that 98% of claims were completed in less than 15 minutes.

QBE's Australian Pacific division first engaged CLARA Analytics in September 2017 for its workers' compensation claims, using CLARA's AI and machine learning products as an early warning system for frontline claims teams.

In December 2018 QBE Australia expanded its adoption of CLARA's product suite across its Australian statutory claims, covering workers' compensation and CTP (auto liability) businesses, and as part of that expansion will deploy CLARA Litigation, a product CLARA describes as designed to avoid and reduce the overall cost of litigation.

A related, undated CLARA blog post, describing the same QBE Australia Pacific claims team, attributes AI and machine learning powered processes to routing high risk claims to experienced adjusters, guiding claims managers toward medical providers likely to produce good outcomes, and scoring cases for overall litigation risk and attorney performance so claims managers know when promptly settling a case is likely to produce the best outcome.