GLOSSARY - INSURANCE
What is Claims Adjudication?
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Quick Answer
Claims Adjudication is the process of evaluating insurance claims to determine coverage, liability, and settlement amount. AI-powered adjudication automates coverage analysis, damage assessment, fraud detection, and settlement calculations while maintaining full audit trails for regulatory compliance.
Definition
**Claims Adjudication** encompasses the complete workflow from First Notice of Loss (FNOL) through settlement. AI systems evaluate policy terms, assess damages, identify fraud, calculate reserves, and recommend settlement amounts—all with explainable reasoning.
Key Points
- Evaluates coverage applicability against policy terms
- Assesses damages using photos, estimates, and historical data
- Flags fraud indicators for special investigation
- Calculates appropriate settlement amounts and reserves
- Ensures compliance with state regulations and company policies
- Provides explainable rationale for every decision