What is Claims Triage?
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Quick Answer
Claims Triage is the process of evaluating incoming insurance claims (FNOL) to determine their complexity, urgency, and required expertise, then routing them to the appropriate adjuster or workflow. AI-powered triage automates this by analyzing claim characteristics, policy details, and historical patterns to make instant routing decisions.
Definition
Key Points
- Analyzes FNOL data to assess claim complexity and severity
- Routes claims to adjusters with appropriate expertise
- Identifies fraud signals for SIU referral
- Prioritizes high-value and time-sensitive claims
- Estimates initial reserves based on claim characteristics
- Reduces average handling time through intelligent routing
How It Works
FNOL Intake
First Notice of Loss data, documents, and images are ingested
Complexity Scoring
AI evaluates claim characteristics, policy terms, and jurisdiction
Risk Assessment
Fraud signals, subrogation potential, and litigation risk are flagged
Adjuster Matching
Claim is routed to adjuster with relevant expertise and capacity
Reserve Estimation
Initial reserves are set based on historical similar claims
Frequently Asked Questions
What factors determine claims triage priority?
Claim severity (injury, total loss), policy value, jurisdiction complexity, fraud indicators, statute of limitations urgency, and customer tier (e.g., commercial vs. personal).
Can AI triage handle all claim types?
AI handles routine auto, property, and general liability claims effectively. Highly complex commercial, aviation, or catastrophe claims still benefit from immediate senior adjuster review.
How fast is AI claims triage?
AI triage completes in seconds vs. hours for manual review. This means claims begin processing immediately instead of sitting in queues.