Business function
First notice of loss, assessment, settlement and recovery of insurance claims.
25 organizations in 13 countries run these use cases in public. 50% of those 26 deployments disclose a measurable outcome.
An AI agent that takes the first notice of loss from a policyholder by phone, chat or app, identifies the policy, collects the facts of the incident and the evidence the claim type needs, opens the claim in the claims system and tells the customer what happens next, handing complex, injured or vulnerable claimants to a human handler.
An AI agent that helps insured travellers around the clock and in their own language: it answers cover questions, takes claims for delays, cancellations, lost baggage and medical costs, reads the receipts and certificates they upload, settles simple claims within set limits, and connects medical emergencies and complex cases to the assistance team at once.
AI that reads each new insurance claim and its documents, scores its complexity, cover questions, fraud and recovery signals, sends it to the right handling path and handler, and settles simple, low risk claims end to end within set limits without a person touching them.
AI that drafts the letters and notices operations must send at scale, such as arrears notices, decline letters, complaint responses, servicing confirmations and product change notices, from case data and approved templates and clauses, in the customer's language, for a person to approve where the notice is regulated.
AI that reads prior authorization requests, medical claims and appeals with their clinical and billing documents, extracts diagnoses, treatments and costs, checks them against the policy and published clinical criteria, and prepares a summary and recommendation for a clinician or adjudicator, who makes every adverse decision.
AI that scores every insurance claim for fraud from first notice of loss onwards, combining claim, policy, document, image and network data to find suspicious claims, organised rings and inflated losses, and sends each alert with its reasons to a claims handler or special investigations unit for review.
Computer vision that assesses damage from photos or video of a vehicle or property taken by the policyholder, a repairer or an adjuster, identifies the damaged parts and the repair or replace decision, produces or checks the repair estimate, and flags total losses and inconsistencies for a person to review.
AI that reads open and closed claims to find cases where a third party is wholly or partly liable, estimates liability and the recoverable amount under the applicable negligence and recovery rules, and sends scored recovery opportunities with their reasons to the subrogation team.
Computed from the 26 public deployments behind these use cases. Numbers update with every checked record.
AXA Switzerland, Acentra Health, Admiral Seguros, AdvanceCare, Allianz Partners, Assurant, Centers for Medicare and Medicaid Services, Central Insurance, Covéa, DOMCURA, Elephant Insurance, Foyer, General Insurance Association of Singapore, Health Resources and Services Administration, Hippo, Hiscox, ICICI Lombard, Lemonade, Manulife, PZU, Progressive, SS&C Technologies, Sedgwick, Tokio Marine & Nichido Fire Insurance, Travelers.
