Insurance claims automation for carriers, MGAs and TPAs. AI reads the FNOL, photos, invoices and reports, checks cover, sets up the claim in Guidewire or Duck Creek, routes it by complexity and flags anomalies to your SIU. People make every payment and denial decision.
Insurance claims automation is the use of AI to handle the repetitive early work on a claim: capturing first notice of loss from email, portals or calls, extracting data from documents and photos, checking it against the policy, and routing the claim by severity. It outputs a structured claim record, a triage decision with reasons, missing-information requests and fraud or leakage flags for human review.
A claim pack arrives as an email thread, a PDF invoice, twenty photos and a phone note. Someone keys it in, checks the policy and guesses the right queue. Slow set-up delays the customer, and rushed set-up is where leakage and fraud slip through.
Average time to final payment on US home insurance claims in J.D. Power's latest property claims study, even after improving.[3]
Of homeowners filed their first notice of loss digitally and those using digital tools reported higher satisfaction.[3]
Of fraudulent general insurance claims detected in the UK in 2024, according to the Association of British Insurers.[2]
Estimated annual US property and casualty insurance fraud within a total fraud cost of $308.6 billion a year.[1]
Reads every document in the claim pack, classifies it, pulls the fields your claims system needs and asks the claimant or broker for anything missing.
Checks the loss against policy dates, limits and exclusions, then routes to straight-through, desk adjuster or field and complex queues with the reasons written down.
Looks for anomalies a busy handler misses: date conflicts, reused photos, duplicate invoices, inflated line items and links to prior claims. Signals go to people.
We take 500–2,000 closed claims and their documents for one line, such as commercial property or motor, set up in your cloud account, and measure current set-up time and routing accuracy.
We configure document extraction, coverage checks and routing against your claims system's test environment and your claims manual, then score accuracy on held-back claims.
New claims are processed in parallel. Handlers see the AI set-up and triage beside their own and mark every disagreement.
We report set-up time, field accuracy, routing agreement and SIU referral quality against baseline, and give you a written go/no-go.
| Criterion | Manual set-up | RPA and OCR templates | Stratgik build + run |
|---|---|---|---|
| Document variety | Handles anything, slowly | Breaks when layouts change | Reads unstructured packs, low-confidence fields to people |
| Coverage check | Handler reads the policy | Not covered | Policy dates, limits and exclusions checked with reasons |
| Triage | Queue by team habit | Fixed rules | Learned from past outcomes, rules you can edit |
| Fraud signals | Experience and luck | Rules on a few fields | Cross-document and prior-claim anomalies for SIU |
| Best fit | Low volume, very complex claims | Stable forms, one channel | Mixed channels and lines at mid-market volume |
| Decisions | Handler | Handler | Handler; AI prepares and explains |
Insurers are being asked to settle faster while catching more. Doing both with the same headcount means taking the keying out of intake and putting judgment where it counts.
Enter your claim volumes. Handling time removed and extra leakage caught are assumptions; the pilot measures both on your claims.
Illustrative estimate using your inputs and stated assumptions, not a quote or guarantee. The pilot measures the real figure against your baseline.
4 weeks · one line of business
per month · one line in production
per month · multiple lines or TPA clients
Model tokens, document OCR pages, image analysis and cloud hosting billed at cost and reported monthly; taxes excluded. GBP and AED prices are indicative conversions from USD.
Accuracy varies by document type and line of business, so we measure it on your own claims. The pilot reports field-level accuracy for each document type, routing agreement with experienced handlers and the precision of fraud referrals. Fields below your confidence threshold always go to a person, so errors are caught at set-up rather than at payment.
No. In our design the AI prepares the claim, checks cover, suggests a route and reserve, and raises signals, but a licensed adjuster or handler makes every coverage, payment and denial decision. This keeps accountability where regulators and customers expect it, and gives you a clear record of what the system suggested and what the person decided.
RPA copies data between screens using fixed rules and templates, so it works well for stable forms but breaks when documents vary. AI claims automation reads unstructured packs such as emails, photos and contractor invoices, understands what each document is, and explains its triage. Many insurers keep RPA for simple system updates and use AI for intake and judgment support.
AI can surface patterns that suggest fraud or leakage, such as date conflicts, edited or reused photos, duplicate invoices and links between claims, but it cannot decide that fraud happened. Signals go to your special investigations unit with the evidence attached. Investigators decide, and their outcomes are used to reduce false positives over time.
Stratgik's pilot is a fixed $22,000 over four weeks for one line of business. Production is $5,500 a month per line, and multi-line or multi-client TPA deployments start from $14,000 a month. Document processing and cloud usage are billed at cost. The calculator above shows handling time and leakage recovered on your volumes.
Claims data stays in your own cloud tenancy in the region you choose, including US, UK and UAE regions. We use model providers that do not train on your data, encrypt data in transit and at rest, and log every access. Your security and data protection teams review the architecture and data processing terms before live claims are processed.
Book a 30-minute call with claims and IT. We will choose the line of business and agree the FNOL-to-triage metric for a 4-week pilot.