AI Claims Processing

Help customers move forward with faster claims decisions

Reduce the wait between a claim and a decision. Our AI Claims Processing supports faster assessment within your rules and controls, with human-in-the-loop where required.

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Claim Trip delayCL-26-0032-7972 · US$63.50

InterpretAirline letter and itinerary read
ValidateStrike covered · 8.25h delay, 6h minimum
Cross-checkFlight records match the airline letter
EvaluateApprove, 95% confidence

Your rules

Assessing against your rules

RecommendationReasoning available

Approve in fullUS$63.50 of US$63.50Covered cause, evidence complete and consistent

Rule: approve automatically up to US$500 at 85%+ confidence Approved

Protect customer trust when a claim puts it to the test

When a customer makes a claim, they are relying on their coverage to work when they need it. Slow decisions, repeated requests for information and unclear processes can quickly erode that trust.

For claims teams, the same journey can involve hours of manual checking across policy terms, documents and claim information. AI Claims Processing takes on more of that assessment work, helping straightforward claims move faster while directing exceptions to the people best placed to handle them.

Reduce manual assessment

Automate repetitive checks and validation across straightforward claims.

Reach decisions faster

Bring together claim information, policy rules and supporting evidence to accelerate assessment.

Apply rules more consistently

Assess claims against insurer-defined criteria across products, partners and markets.

Focus expertise where it matters

Surface claims that require further investigation or human judgment.

What happens between submission and decision

Specialized AI agents each take on part of the assessment against the rules you have configured, and your claims team receives one recommendation with its status, proposed claim amount, confidence score and full rationale

01Document agent
Interpret

Read claim information and supporting documents and extract relevant data for assessment
02Coverage agent
Validate

Check coverage, conditions, exclusions and required evidence against configured rules
03Verification agent
Cross-check

Compare claim information across available data sources to identify inconsistencies, anomalies or potential fraud indicators
04Decision agent
Evaluate

Bring the findings together against the applicable claims rules and thresholds to determine the appropriate next action

AI recommendation for a trip delay claim: approve US$63.50 of US$63.50 claimed, 95% confidence, with a reasoning summary and the detailed reasoning

AI that works within your claims framework

AI Claims Processing does not operate on its own terms. Your team defines the rules, conditions, exclusions and thresholds it applies, and the points at which a person reviews a claim.

You define the rule
Coverage conditions, exclusions, evidence and limits, set for each product, partner and market
Human review where required
Choose the amounts, confidence levels and risk indicators that send a claim to a handler
Your team has the final say
AI supports decisions rather than making them in a black box. Handlers see the reasoning and can accept or override any recommendation

Claims rulesSet by your claims team

Travel delay · Partner A · Singapore

Coverage

Covered causes: Strike, severe weather, technical fault
Minimum delay: 6 hours
Required evidence: Airline letter, itinerary, receipts

Routing

Up to US$500 and 85%+ confidence: Approve automatically
Over US$500 or below 85% confidence: Claims handler
Potential fraud indicator: Investigations team
Any decline recommendation: Claims handler

Part of the end-to-end claims journey

AI Claims Processing supports discovermarket’s claims solution. Claims reported through the Claims Reporting Portal arrive structured and complete, and each recommendation is applied according to your rules: approved automatically or passed to your claims team to decide.

Explore Claims Reporting