ClaimSight

A regional insurer triaged claims in the order they arrived. Severe losses and obvious fraud sat in the same queue as routine glass claims, and adjusters could not tell which was which until they opened the file.

Suspicious claims slipped through to payment because no one had time to investigate every one, and the cost of that leakage was hard to see until the numbers came in at year end.

ClaimSight reads each new loss as it is reported, scores it for severity and fraud risk, and routes it to the right path. Fast-track claims move quickly, complex losses reach a field adjuster sooner, and suspicious ones surface for review before money goes out.

• •Severity scoring at first notice of loss, with automatic routing by complexity
• •Fraud signals drawn from coverage timing, prior claims, identity links, and documentation gaps
• •Triage board that shows every claim by stage and risk at a glance
• •Claim detail with the fraud score and the specific signals behind it
• •Analytics on leakage prevented, top fraud signals, and SIU outcomes

When a claim is reported, the system scores it and places it on the board. Low-risk claims are flagged for fast-track, high-severity losses are routed to the right adjuster, and claims with strong fraud signals are held for review.

AI does the scoring and surfaces the reasoning. Adjusters and the SIU team make every call. Each decision is logged and timestamped, so the audit trail stays complete.

Severe and suspicious claims get attention first instead of waiting their turn.

Routine claims move through faster because they are recognized as routine.

The cost of leakage becomes visible and defensible instead of a year-end surprise.