We built a comprehensive claims automation platform over 14 weeks. (1) Digital FNOL: multi-channel digital claims intake — mobile app (photo-based damage documentation for motor and property), web portal, and AI-powered phone intake (voice agent handling standard FNOL calls). Auto-population: customer and policy data pre-loaded from the policy system — the customer confirmed rather than re-provided their information. Damage documentation: guided photo capture through the mobile app — AI models assessed damage severity from photos, providing immediate preliminary estimates for motor claims. Digital FNOL reduced intake time from 12 minutes to 4 minutes (phone with voice agent) and 3 minutes (mobile app).
(2) Automated claims processing: coverage verification (automated checking of policy terms, coverage limits, deductibles, and exclusions — instant coverage confirmation for standard claims), reserve setting (ML-based reserve estimation using claim characteristics, historical development patterns, and current repair cost indices — producing consistent, data-driven initial reserves), routing (automated assignment of claims to appropriate handlers based on complexity, line of business, and required expertise — simple claims routed to straight-through processing, complex claims to specialist handlers), and straight-through processing (standard motor claims under EUR 2,000 with photo documentation processed automatically — damage assessment, repair authorisation, and payment without handler intervention). (3) AI fraud detection: ML fraud models trained on 5 years of claims data (15 million claims, including known fraud cases). Network analysis: identifying connected claims (shared addresses, phone numbers, repair shops, medical providers, and legal representatives) that indicated organised fraud rings.
Behavioural analysis: detecting anomalies in claim patterns — filing timing, damage descriptions, medical treatment patterns, and document characteristics that deviated from legitimate claim patterns. Fraud scoring: every claim scored for fraud probability — high-risk claims routed to the investigation team with specific risk indicators highlighted. Investigation prioritisation: fraud team focused on the highest-value, highest-probability cases — replacing the previous approach of investigating a random sample of flagged claims. (4) Supplier network automation: digital referral — automated matching of claims to optimal suppliers based on location, specialisation, quality ratings, cost performance, and current capacity. Electronic authorisation: suppliers received work authorisations digitally with scope of work, authorised amounts, and timeline expectations. Digital invoicing: suppliers submitted invoices electronically — automated three-way matching against authorisation, scope of work, and market-rate benchmarks. Quality tracking: automated capture of customer satisfaction data for each supplier interaction — feeding back into the supplier selection algorithm.
(5) Customer communication: automated status updates — customers received proactive notifications at every stage (claim received, coverage confirmed, supplier assigned, repair scheduled, payment processed) through their preferred channel. Status portal: real-time claim status accessible through the mobile app and web portal — eliminating the need for status enquiry calls. Estimated timeline: AI-generated claim timeline showing expected milestones — customers knew when to expect resolution rather than calling to ask.