We built a 4-component AI claims workflow over 10 weeks. (1) Claims Intake Engine: processing damage notifications across all channels. The engine: transcribing phone notifications using speech-to-text with Swedish insurance vocabulary (skada, självrisk, stöld, inbrott, vattenskada, trafikskada), extracting structured data from web and app notifications, automatically linking claims to policies (from 2.1M active policies — using personnummer, policy number, or property address for matching), performing initial damage assessment from submitted photographs (AI image analysis classifying damage type — stöt/buckla/repor for motor, vattenskada/brandskada/inbrott for home — and estimating severity), identifying obviously incomplete notifications and generating immediate follow-up requests (missing photos, missing police report number, insufficient damage description), and classifying claims by type and estimated complexity (simple — straightforward damage, clear coverage, likely under SEK 25,000 — vs. complex — multi-party, coverage questions, potential fraud indicators, high value). Intake processing: 3 minutes per claim (from 15-20 minutes manual).
Immediate completeness check: 95% of missing documentation identified within 1 hour of notification (vs. 3-5 days manually). (2) Coverage and Assessment Engine: automating claim evaluation against policy terms. The engine: retrieving the correct policy version and applicable terms (matching policy inception date, endorsements, and renewal history), verifying coverage (peril covered, policy active, exclusions checked, deductible identified — with confidence score for each verification step), calculating claim value (motor: comparing submitted repair estimate against DRG benchmark data — flagging estimates significantly above benchmark for review; home: assessing repair costs against market rates, replacement values against depreciation schedules per policy terms), determining liability for motor claims (applying trafikskadelagen strict liability rules, apportioning contributory negligence for multi-vehicle incidents based on police report and damage evidence), and generating settlement recommendations with detailed reasoning. Coverage verification accuracy: 99.1% (from 97.6% manual). Assessment consistency: variation between similar claims reduced by 65% (eliminating handler-dependent assessment differences).
(3) Subrogation Engine: automating recovery identification and pursuit. The engine: identifying subrogation-eligible claims (motor claims where the policyholder was not at fault — based on police report analysis, liability determination, and damage evidence), generating regresskrav (subrogation claims) to the at-fault party's insurer with all supporting documentation, tracking recovery progress and sending follow-up communications on schedule, and escalating disputed subrogation claims to specialist handlers. Subrogation recovery rate: increased from 62% to 88% of eligible claims — SEK 48M in additional annual recoveries. (4) Workflow Orchestration Engine: managing end-to-end claims processing.
The engine: routing claims based on complexity and value (simple claims — clear coverage, under SEK 25,000, complete documentation — fast-tracked with automated assessment and direct settlement; complex claims — coverage questions, high value, fraud indicators — routed to specialist handlers with pre-assessed dossiers), generating customer communications (in Swedish — status updates, document requests, settlement notifications — maintaining a warm, professional tone aligned with the company's brand), coordinating with repair shops (for motor direct-settlement claims — sending authorisation and tracking repair progress), producing management reports (processing times, settlement ratios, handler productivity, customer satisfaction metrics), and generating Finansinspektionen regulatory reports.