Automated Claims Processing

Challenges

• Claims were received via multiple channels, primarily emails with unstructured attachments like PDFs, images, and reports.​
• Claims processors manually read through documents to find and extract key information (policy number, claimant name, date of loss, etc.), a process that was slow and highly prone to human error.​
• Manually keying the extracted information into the core Claims Management System was a time-consuming, bottleneck due to its repetitive nature.​
• Tracking the status of incoming claims was done manually in spreadsheets, offering no real-time visibility to management.​

Solutions

• An intelligent automation solution monitors the claims inbox 24/7, ingesting new claims automatically. ​
• The flow uses AI and Intelligent Document Processing (IDP) to accurately read, classify, and extract data from all submitted documents. ​
• An RPA bot validates the extracted data against business rules and populates the Claims Management System to create a new claim record instantly. ​
• The bot automatically triages the claim based on predefined rules (e.g., claim type, value, location) and assigns it to the appropriate adjuster’s queue. ​
• The solution provides real-time updates to a SharePoint list and Power BI dashboard for complete process transparency and tracking.​