S-ASHWATH / DOMAIN_03 / INSURANCE

Claims intelligence
for insurance
operations.

India processes over 250 million claims annually. The bottleneck isn't volume — it's the hours adjusters spend manually reviewing FNOL submissions, cross-referencing policy terms, and pattern-matching fraud signals before making a triage decision. This agent does that in seconds.

250M+Claims filed in India per year

₹45,000 CrEstimated annual fraud losses

60%Adjuster time on documentation

01The Problem

// The Pain

Adjusters are buried in FNOL forms

A standard first notice of loss file carries 6–10 attachments — FIR, survey reports, hospital bills, repair estimates, photographs, and witness statements. Reading all of it before making a triage decision takes hours. Actual judgment gets the last 20 minutes.

// The Risk

Fraud signals vanish in the queue

A motor claim filed the day after a 2-month-old policy is issued, for an amount above policy value, by an insured with 3 prior claims — each flag alone is a mild yellow. Together they are a clear refer-to-SIU. Manual review misses the combination.

// The Approach

AI triage with structured fraud scoring

The agent cross-references the primary FNOL signals — policy age, incident type, claim amount, filing delay, and claims history — applies underwriting logic, and produces a structured brief with a fraud score and triage recommendation the adjuster can act on immediately.

// The Target

Insurers, TPAs, and InsurTech platforms

Built for first-party claims teams, third-party administrators onboarding high-volume portfolios, and embedded insurance platforms where triage speed is a direct cost-of-claims lever.

02The Triage Signal Logic

FNOL

First Notice of Loss

Policy type, incident category, and claim quantum. The primary triage layer — determines coverage perimeter and expected settlement range before any investigation begins.

BEHAV

Behavioral Signals

Policy age at filing, days from incident to report, and 3-year claims frequency. Each flag is mild alone; in combination they form the clearest early fraud pattern available at intake.

AMOUNT

Quantum Analysis

Claim amount indexed against policy-class typical ceilings. Values above 1× ceiling trigger surveyor requirements; values above 2× ceiling require mandatory independent assessment before adjudication.

SCORE 0 – 1

LOW

FAST_TRACK or STANDARD

SCORE 2 – 3

MEDIUM

STANDARD processing

SCORE 4 – 6

HIGH

INVESTIGATE before advance

SCORE 7+

CRITICAL

REFER to SIU immediately

03Claims Triage Agent · Live

CLAIMS TRIAGE AGENT

// INS_A1 · DOMAIN_03

// FNOL Profile

◈

Enter FNOL details and run assessment.
Triage brief generates in under 10 seconds.