Automated claims processing for a US insurance firm

The challenge

A mid-market insurer processed 40,000+ claims a year across four regional offices using spreadsheets, email threads and a legacy AS/400 system. Every claim touched five people before a decision. Turnaround averaged 9 business days and dispute rates were climbing.

Our approach

• 01

  Mapped the end-to-end claims lifecycle with adjusters and IT — surfaced 23 handoffs, 11 of them redundant.

• 02

  Built a rules engine that auto-adjudicates 62% of routine claims and routes only exceptions to human reviewers.

• 03

  Integrated with the existing policy system via a thin API layer — no rip-and-replace.

• 04

  Rolled out office by office over 90 days with side-by-side shadow runs to protect audit trails.

Outcomes

• 60%

  faster turnaround
• 62%

  claims auto-adjudicated
• $1.4M

  annual ops savings
• 9→3

  days to decision