We built a 4-component AI claims workflow over 11 weeks. (1) Claims Intake Engine: automating the processing of broker loss notifications. The engine: receiving notifications across channels (email, Lloyd's CLASS, broker portals), classifying document types within each notification (loss notice, adjuster report, surveyor report, coverage opinion, photographs, invoices), extracting structured claim data from unstructured documents (loss date, loss description, affected location, estimated loss amount, policy reference, broker reference, claimant details), cross-referencing extracted policy references against the syndicate's policy database to automatically link claims to policies, and creating claims records in the claims management system with all extracted data pre-populated. Extraction accuracy: 97.8% across key fields. Processing time: 45 seconds per claim intake (from 22 minutes manual data entry). Data entry errors: eliminated (0% vs. 6.2%). (2) Coverage Verification Engine: automating policy coverage analysis.
The engine: retrieving the full policy wording (including all endorsements, clauses, and territorial limitations) for the linked policy, analysing the claim against policy terms — checking: peril coverage (is the loss cause covered?), territorial scope (did the loss occur within covered territory?), policy period (did the loss occur during the coverage period?), exclusions (do any policy exclusions apply?), deductibles and retentions (what is the insured's retention?), sub-limits (are any sub-limits applicable to this loss type?), generating a coverage opinion with confidence score — clearly identifying which terms apply, which exclusions might be relevant, and what the deductible/retention structure is, and flagging ambiguous coverage situations for human review (overlapping exclusions, aggregation questions, complex territorial issues). Coverage verification time: 3 minutes per claim (from 35-55 minutes). Coverage errors: reduced from 2.8% to 0.3% (the remaining 0.3% involved genuinely ambiguous coverage situations that the system correctly escalated for human review).
(3) Reserve Intelligence Engine: automating initial reserve setting with actuarial-quality estimates. The engine: analysing the claim against historical claims data (15 years of claims history, 340,000+ closed claims with known ultimate costs), matching the current claim to similar historical claims based on: loss type, property type, geographic location, policy year, loss size indicators, and complexity indicators, applying development factors based on claims maturity and class of business, and producing initial reserve recommendations with confidence intervals. Reserve accuracy: ±18% (from ±38%). Reserve volatility: significant reduction in reserve adjustments — 40% fewer reserve movements in the first 6 months. (4) Workflow Orchestration Engine: automating the end-to-end claims workflow.
The engine: routing claims based on complexity and value (routine claims under £25,000 fast-tracked with minimal human touchpoints, complex claims routed to specialist handlers with pre-compiled dossiers), generating following market notifications automatically (formatted per Lloyd's Market standards, sent via ECF — Electronic Claims File — where possible, email for markets not on ECF), tracking following market responses and escalating non-responses after defined periods, generating claims reports for management (reserve summaries, open claims aging, handler workload distribution), and producing Lloyd's Minimum Standards compliance documentation automatically.