Claim Triage Scoring
Instantly prioritize incoming claims based on complexity, severity, and expertise required. Route to the right adjuster from day one.
Insurance
Claims decision infrastructure
Expert reasoning for the modern claims department
Claim triage, coverage reasoning, and subrogation signals — built from real adjuster expertise with audit-ready decision trails. Sits on top of Guidewire, Duck Creek, and your existing CMS.
40%
Faster claim handling
85%
Decision accuracy on coverage calls
2×
Subrogation signal detection
100%
Audit trail on every decision
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.
Pilot design targets — derived from benchmarking against historical claims workflows and expert-reviewed decision datasets. 90-day pilot framework and benchmarking methodology.
Decision paths
What claims teams verify first
Three high-stakes claims workflows — each with policy citations and audit-ready rationale.
Claims Triage
Prioritize complexity, severity, and expertise required. Route to the right adjuster from day one.
Coverage Reasoning
Match policy language to claim facts with cited provisions on every coverage decision.
Subrogation Detection
Surface third-party liability and recovery signals early — before opportunities are missed.
See the output
What your adjusters receive on every decision
Illustrative mockups — not live customer claims. Shows cited policy language, reasoning, confidence, and audit fields returned to Guidewire or Duck Creek.
See the full decision output
Enter your work email to explore coverage, subrogation, and audit trail examples — the same format adjusters see in a pilot.
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The challenge
The Claims Challenge
Why legacy automation fails in regulated workflows.
60%
of adjuster time spent on routine tasks AI should handle
30%
of subrogation opportunities missed without expert-guided triage
40%
of claims escalated due to inconsistent first-pass routing
25 yrs
average experience lost when senior adjusters retire
Capabilities
What Claims Does
Purpose-built reasoning for your domain experts.
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.
Workflow
How Claims Works
From intake to expert handoff in five steps.
01
Claim Intake
FNOL data flows into the claims workflow. Documents, photos, and descriptions are parsed and structured.
02
Policy Match
Policy terms are matched against claim facts, identifying applicable coverages and exclusions.
03
Triage Score
Claims receive priority scores based on complexity, value, and required expertise level.
04
Reasoning Output
Coverage recommendations, subrogation signals, and reserve estimates with full reasoning trails.
05
Expert Handoff
Complex claims route to senior adjusters with full context. Simple claims fast-track to resolution.
Decision overlay vs. other approaches
IntelliHuman adds reasoning and audit trails on top of your existing Guidewire or Duck Creek stack — a different layer than generic AI, rules automation, or outsourced review.
Full capabilityPartial / LimitedNot available
Benchmark
IntelliHuman Claims
Generic LLM
ChatGPT, Claude
Rules-only automation
RPA, scripts
Claims BPO
Outsourced review
Policy interpretation with citations
IntelliHuman Claims
Generic LLM
Rules-only automation
Claims BPO
Policy interpretation with citations
Subrogation signal detection
IntelliHuman Claims
Generic LLM
Rules-only automation
Claims BPO
Subrogation signal detection
Exportable audit trail per decision
IntelliHuman Claims
Generic LLM
Rules-only automation
Claims BPO
Exportable audit trail per decision
Human override with reason capture
IntelliHuman Claims
Generic LLM
Rules-only automation
Claims BPO
Human override with reason capture
CMS overlay (no rip-and-replace)
IntelliHuman Claims
Generic LLM
Rules-only automation
Claims BPO
CMS overlay (no rip-and-replace)
Continuous learning from adjuster feedback
IntelliHuman Claims
Generic LLM
Rules-only automation
Claims BPO
Continuous learning from adjuster feedback
Typical time to pilot value
Weeks
Unpredictable
3–6 mo
2–3 mo
Regulatory defensibility
High
Low
Moderate
Moderate
Your claims CMS (Guidewire, Duck Creek, Majesco) remains your system of record. IntelliHuman integrates as a decision layer — we do not replace or compete with your CMS.
Design partner program
Verify outcomes on your claims stack — not ours
IntelliHuman is an early-stage company. We do not publish customer case studies yet. Instead, we work with a small number of design partners on structured 90-day claims pilots — measured against your baselines, on your Guidewire or Duck Creek environment.
Accepting a limited number of claims design partners for 2026.
What design partners get
Structured 90-day pilot
Agreed KPIs, baseline capture, and before/after measurement — no long-term contract required.
Roadmap influence
Early partners shape triage, coverage, and subrogation workflows for production claims operations.
Co-publication option
If the pilot succeeds, anonymized outcomes may be published — only with your explicit permission.
Preferred commercial terms
Design partners receive favorable pricing if you expand after a verified pilot.
What we look for
- 500+ claims per month in the target workflow (triage, coverage, or subrogation)
- Guidewire, Duck Creek, or other digital CMS with API access
- Executive sponsor and claims operations stakeholder
- Willingness to share anonymized before/after metrics
Integrations
Works With Your Systems
Connect to your existing enterprise stack.
GuidewireDuck CreekMajescoSnapsheetCustom API
Works with your existing CMS — Guidewire, Duck Creek, and your core systems. An overlay, not a replacement.
FAQ
Common Questions
Ready to verify claims decision infrastructure?
Start a 90-day claims pilot — triage, coverage reasoning, or subrogation — with before/after KPI measurement and full audit trails.