FROM:
Five-day manual claims processing vulnerable to fraud.
TO:
Automated 48-hour handling with AI fraud detection yielding 30% fewer false payouts and $115 lower cost per claim portfolio-wide.
Fixing Delays and Reducing Risk
A regional insurer was overloaded with claims. Adjusters reviewed each case manually, often juggling documents, calls, and spreadsheets. Fraud slipped past, and legitimate claims stalled. The process took about five days on average — and longer during peak periods.
They wanted faster decisions without sacrificing accuracy.
What Was Holding Them Back
Our review uncovered clear constraints:
- Manual data entry slowed every step
- Adjusters lacked tools to detect suspicious patterns
- Claim documents required repeated review
- Workloads fluctuated, creating inconsistent turnaround times
The system wasn’t built for volume or complexity.
A Smarter Claims Engine
We worked with their claims operations teams to create an AI-guided claims process:
- Automated triage flagged unusual behavior and routed cases by risk level
- Document extraction tools reduced repetitive manual work
- Repeat claim patterns and anomalies surfaced instantly
- Routine claims flowed straight through with minimal human touch
Processing time dropped dramatically.
Outcome & Takeaway
- Claims resolved in under 48 hours
- Fraudulent payouts fell notably
- Cost per claim dropped by more than $100
The insurer gained both efficiency and protection, and adjusters finally had time for complex cases rather than paperwork.
