Pilot design targets — derived from benchmarking against historical claims workflows and expert-reviewed decision datasets. Your 90-day pilot verifies these on your production data. Prior authorization and logistics exception workflows use the same decision infrastructure and are available as secondary paths after claims verification.
Claims Triage
Insurance — P&C, TPA
Problem Incoming claims volume outpaces adjuster capacity. Manual prioritization is inconsistent — high-severity and subrogation-rich files get buried.
Workflow capability Severity scoring, complexity routing, and SLA-aware prioritization built from adjuster expertise. Returns scores and rationale to Guidewire or Duck Creek; adjusters accept, override, or escalate.
Inputs
• FNOL data
• Policy metadata
• Historical loss patterns
Outputs
• Triage score
• Routing recommendation
• Cited rationale
Pilot design targets
Pilot design target: faster time-to-first-touchReduced mis-routed claimsConsistent severity scoring
Coverage Determination
Insurance — P&C
Problem Coverage calls require reading policy language, endorsements, and facts of loss — slow, inconsistent, and hard to audit when challenged.
Workflow capability Policy-cited coverage reasoning with confidence scores and alternative interpretations flagged. Every recommendation includes exportable audit fields for compliance and litigation prep.
Inputs
• Policy documents
• Endorsements
• Loss details
• Prior claim history
Outputs
• Coverage recommendation
• Policy citations
• Confidence and alternatives
Pilot design targets
Pilot design target: faster coverage decisionsCited policy language on every outputReduced rework on disputed calls
Subrogation Identification
Insurance — P&C
Problem Subrogation opportunities are missed when adjusters lack time to cross-reference liability signals across files and third-party data.
Workflow capability Early subrogation signal detection with liability reasoning and recovery potential scoring. Flags candidates for specialist review before the statute clock runs.
Inputs
• Claim facts
• Police reports
• Third-party identifiers
• Prior subrogation outcomes
Outputs
• Subrogation likelihood
• Liability reasoning
• Recovery priority score
Pilot design targets
Pilot design target: earlier subrogation identificationHigher recovery capture rateAudit-ready liability rationale