Straight-through processing
Routing rules and document extraction for the claims that need no human judgement, with a monitored threshold governing what escalates to a person.
Claim volume is rising, adjuster capacity is not, and every automated decision now has to be explainable. We build the systems that absorb the volume without creating a governance problem.
Automation pays off where the decision is routine and the exceptions are well understood. We start by separating the two, which is usually the hardest part of the engagement.
Routing rules and document extraction for the claims that need no human judgement, with a monitored threshold governing what escalates to a person.
First notice of loss documents, medical records and repair estimates parsed into structured fields, with confidence scores driving the escalation rules rather than sitting in a report.
Third-party data brought in at quote time, with lineage and licensing recorded so the pricing decision can be defended later.
Summarization and next-best-action inside the tools adjusters already use, scoped so the system drafts and the adjuster decides.
State regulators now expect carriers to govern their models the way banks govern credit models. In practice that is a documentation and monitoring problem more than a modeling one.
One register of the models in production: what each decides, what data it uses, and who owns it. It is the first thing a market conduct examination asks to see.
Disparate impact testing on the classes your regulators care about, run on a schedule and recorded, rather than performed once before launch.
Reason codes a policyholder can understand and a regulator can verify, generated from the same model that made the decision.
How we help
Automate the routine. Govern the rest.
The carriers that get this wrong automate the decisions they cannot explain. Separating those two categories honestly is most of the work.
A 20-minute call with a senior consultant. You’ll leave with a clear next step, whether or not we work together.