01
Complete claim file
Evidence is extracted, reconciled and checked before assignment.
Less handling effort and fewer avoidable back-and-forth cycles.
From first notice to claims decision
One claim, one evidence trail, one governed path to resolution.
FirstVal customer — multi-line insurance provider
Claims operations and customer service
- Minutes
- To complete first triage
- One view
- Across evidence and decisions
- Human-led
- For judgement and exceptions
01 — The intro
Where the story starts
A claim arrives as a story spread across forms, photographs, call recordings, policy documents and repair estimates. The work is not simply reading each item; it is deciding what matters, what is missing and who should act next.
The insurer wanted faster service without turning a sensitive customer moment into an opaque automated decision. The answer was a claims operating layer that assembles evidence, applies policy and keeps an adjuster responsible for judgement.
- Input reality
- Multimodal
- Decision flow
- Fragmented
- Control point
- Late
Forms, calls, images, estimates and policy language described one event in different ways.
Evidence collection, coverage review and routing lived across separate queues.
Missing facts and suspicious patterns often surfaced after significant handling effort.
02 — The challenge
Turn fragmented claim evidence into a complete, defensible decision path without slowing honest customers or weakening controls.
- —Evidence entered through different channels and reached different teams in inconsistent formats.
- —Adjusters repeated document checks before they could assess coverage, severity or next action.
- —Potential fraud indicators and missing evidence were discovered late in the journey.
- —Customers had little visibility into what was holding a claim or what they needed to provide.
Improve
Decision readiness and customer clarity
Reduce
Avoidable handling and claim leakage
03 — The solution
A multimodal claims twin and governed agent team that organises evidence, recommends a route and records why.
- 01Connected first-notice forms, calls, images, policy wording and repair documents into one claim timeline.
- 02Used document and vision models to identify damage, extract entities and flag evidence gaps.
- 03Retrieved the applicable policy clauses with citations rather than generating an unsupported coverage answer.
- 04Scored complexity, severity and fraud indicators to recommend straight-through, adjuster or specialist review.
- 05Presented the recommendation, confidence and contrary evidence to the claims handler for approval.
- 06Triggered customer updates and evidence requests from the approved decision state.
- 07Captured every model, rule, source and human intervention in an audit-ready decision record.
Impact
Claims entered the right operating path with the evidence and rationale attached.
04 — Value logic
How operating change reaches financial value
02
Risk-based routing
Each claim moves to the least costly path consistent with its complexity and risk.
Specialist capacity concentrates on files where judgement changes the outcome.
03
Cited policy reasoning
Recommendations link to wording, evidence and approval history.
Lower dispute exposure and more consistent settlement decisions.
05 — Feature delight
What people actually felt
01
Evidence that explains itself
Handlers see the source page, photograph or call segment behind every extracted fact and recommendation.
02
A clear next action
Customers and handlers know what is missing, who owns it and what changes when it arrives.
03
Judgement stays human
The agent prepares and routes the file; consequential coverage and settlement decisions remain with authorised people.
06 — Ground impact
What moved, and by how much
Faster
Decision readiness
Evidence is assembled before the file reaches the handler.
Earlier
Risk detection
Contradictions and network signals surface at intake rather than after settlement.
Clearer
Customer journey
Requests and status updates reflect the actual decision state.
Replayable
Governance
Every recommendation can be reconstructed from source to approval.
07 — Measurement
How the result stays accountable
Flow
Track time from first notice to a decision-ready file, including evidence-request loops.
Quality
Measure reopened claims, routing changes and decisions returned for missing evidence.
Economics
Compare handling cost, leakage indicators and specialist effort by claim path.
08 — CSAT score
Scored by the customer, A+ to D
A faster claim was valuable only when the decision remained explainable, reviewable and fair.
- A
- Claims-handler experience
- A+
- Evidence traceability
- A
- Customer communication
- A+
- Decision governance
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