IntelliHuman AVI Claims
Decision intelligence for modern claims operations
AVI Claims adds a decision support layer on top of your existing systems. It combines claim facts, policy rules, and adjuster expertise to guide consistent, audit-ready decisions in real time.
Start with decision support and expert escalation. Then automate repeatable decisions with confidence, without disrupting current claims workflows.
Decision cycles compress with guided, policy-native reasoning
Coverage and triage decisions align across adjusters and teams
Missing evidence and subrogation opportunities are surfaced early
Every recommendation includes audit-ready rationale and citations
The Claims Challenge
The biggest constraint is decision quality at scale, not document collection. Teams need faster outcomes without sacrificing consistency, explainability, or control.
Critical
decision bottlenecks slow claims when policy interpretation and judgment stay fully manual
Frequent
missing information creates rework loops, longer cycle times, and inconsistent outcomes
High
variation between adjusters forces senior review on cases that should be straightforward
Rising
compliance pressure demands audit-ready reasoning for every decision, not just outcomes
What AVI Claims Does
Six core capabilities that transform how your claims department operates.
Claim Triage Scoring
Instantly prioritize incoming claims based on complexity, severity, and expertise required. Route to the right adjuster from day one.
Coverage Reasoning
Analyze policy language against claim facts to determine coverage applicability. Cite specific provisions for every decision.
Subrogation Detection
Identify recovery opportunities that human review might miss. Flag third-party liability signals automatically.
Reserve Estimation
Generate accurate initial reserves based on claim characteristics and historical patterns from experienced adjusters.
Fraud Signals
Surface red flags and anomalies that warrant investigation. Based on patterns from fraud investigators.
Expert Routing
Match complex claims to adjusters with relevant expertise. Ensure specialized claims get specialized attention.
How We Compare
AVI Claims vs. common solutions in insurance claims processing
Need a broader framework? See all comparison guides including IntelliHuman vs Guidewire and Vertical AI vs General LLMs.
* General AI requires significant prompt engineering and lacks insurance-specific accuracy guarantees
Sources and assumptions: internal benchmark observations, publicly documented product capabilities, and implementation constraints. See methodology notes in comparison resources.
How AVI Claims Works
Roll out in phases: support adjusters first, escalate edge cases with context, then automate repeatable decision paths.
Watch how AVI Claims upgrades claims workflows from processing to decision intelligence
Decision Support Layer
AVI Claims sits on top of your existing claims stack and ingests claim facts, policy data, and context without replacing core systems.
Policy + Evidence Reasoning
The system interprets policy language against claim facts, flags missing information, and prepares defensible decision recommendations.
Consistency and Confidence
Claims receive confidence and complexity signals so straightforward cases are handled consistently and faster.
Edge-Case Escalation
True edge cases route to senior adjusters with full reasoning context, preserving human judgment where it matters most.
Phased Automation
As confidence grows, repeatable decisions can be executed end-to-end while maintaining governance and auditability.
Every Decision Has an Audit Trail
AVI Claims documents its reasoning for every coverage determination, triage decision, and subrogation flag. When regulators ask "why did you decide that?"—you have the answer.
- Policy provision citations
- Fact-to-coverage mapping
- Decision confidence scores
- Expert knowledge sources
Integrations
AVI Claims connects with your existing claims management systems. See our integration options and enterprise capabilities.
Powered by the IntelliHuman Brain
AVI Claims is built on our proprietary IntelliHuman Brain, trained on expertise from Subject Matter Experts. Learn more about our insurance solutions and enterprise platform. It's trained on expertise from seasoned claims adjusters, SIU investigators, and coverage attorneys. It reasons like your best people—and gets smarter with every decision.
Learn About the IntelliHuman BrainInsurance Claims Workflows
See how IntelliHuman automates complex claims workflows with explainable AI
Claims Triage Workflow
How AI automates intelligent claim prioritization and routing based on complexity and expertise required
Coverage Determination Workflow
How AI analyzes policy language against claim facts to determine coverage applicability
Subrogation Identification Workflow
How AI detects third-party liability and recovery opportunities that manual review might miss
SIU Referral Workflow
How AI identifies fraud indicators and routes suspicious claims to Special Investigation Units
Reserve Estimation Workflow
How AI calculates initial claim reserves using historical comparables and claim characteristics
Insurance Compliance Posture
Learn how IntelliHuman ensures regulatory compliance and fair claims handling practices
Key Concepts in Insurance AI
Understand the core terminology behind intelligent claims processing
Claims Triage
Intelligent prioritization of incoming claims
Coverage Reasoning
AI analysis of policy vs. claim facts
Subrogation Detection
Automated recovery opportunity identification
Fraud Detection
AI-powered fraud pattern recognition
Policy-Native AI
AI that understands insurance policy language
Intelligent Reasoning Platform
Decision-making AI with explainability
Explainable AI
Transparent AI decision-making
Audit-Ready Automation
AI with complete audit trails
Ready to Transform Your Claims Department?
See how AVI Claims can reduce handling time by 40% while improving decision accuracy.