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The Tier 1 insurance company was facing a high volume of claims requiring significant manual e ort, combined with a heavy reliance on unstructured data such as emails and documents. Ensuring consistency and compliance in claims assessment also led to slower decision-making and impacted customer experience.
Celfocus developed an AI-driven solution to automate the processing of claims, enabling the extraction and interpretation of unstructured inputs.
The solution validates loss notifications against policy clauses and conditions, generating approval or rejection presented to the agent. This approach follows human-in-the-loop validation, ensuring decisions remain aligned with regulatory requirements and internal policies.
The solution offers:
