Claims Processing Bot

The Problem

When a claim comes in, an adjuster has to open the notification, read through the description, pull up the policy, check what is covered, verify excesses, review any supporting documents like photos or repair quotes, and then decide on next steps. For straightforward claims, this process takes far longer than the actual decision. For complex claims, the time spent on data gathering delays the assessment that the claimant is waiting for. Australian general insurers handle high volumes of motor, home, and weather-related claims, and every delay hits customer satisfaction and operational costs.

How It Works

The agent processes incoming claim documents, extracting key information: what happened, when, policy number, claimed amount, and supporting evidence. It matches this against the relevant policy in your claims platform, checking coverage, exclusions, and excess amounts. Straightforward claims that clearly fall within policy terms are flagged for fast-track approval. Claims that need investigation, such as those with fraud indicators or complex liability questions, are routed to an adjuster with a prepared summary so they can start their assessment immediately.

Australian Insurance Context

After major weather events, claims volumes spike and processing times blow out. This is when automation matters most. The agent integrates with platforms like Guidewire ClaimCenter and Duck Creek Claims, fitting into your existing workflow. We have built similar document processing pipelines for insurance organisations before. See how we approached automating insurance claim preparation and our work on the BOM weather data pipeline for an insurance tech company.