Claims coverage engine
A coverage engine for private liability claims: claims selected for checks, the checks running against coverage conditions written in natural language, results per condition with the reasoning and the identified customer, and the conditions themselves added, modified and tested on a claim, with the guardrail that no payout is refused without a human confirming.
One working session with the people in the seat: which decisions, which systems, what a good week looks like.
The app you see above, running on your own exports instead of the simulated world. Every screen, every decision, your numbers.
Wired to your systems with your permissions, agents proposing, people approving, the ledger recording who did what.
Overview
A claims handler reads each claim letter against the policy conditions and decides. The conditions live in a product document, the decisions vary by handler, and a new product or regulation means retraining everyone.
The engine runs each claim's description and attachments through the coverage conditions with multimodal models and shows, per condition, whether the claim is covered and why, with the customer identified from the policy. Conditions are written and edited in plain language and tested on a real claim before they go live. A failed check is a determination for a human to confirm; the system never refuses a payout on its own.
Key features
- Claims ingestion: notional or own claims run through the customizable coverage engine.
- Multimodal AI review: natural-language and image understanding of claims against pre-defined, editable coverage conditions.
- Dynamic reporting: results per check with reasoning, reviewed and validated per claim.
- Ethical AI guardrails: a human confirms any determination that would prevent a payout.
Decisions it produces
- Start coverage checks on selected claims
- Confirm a not-covered determination
- Add or modify a coverage condition
- Re-run checks after a condition changes
Data sources
| Claims | descriptions, amounts, attachments |
|---|---|
| Policy administration | policy numbers and holders |
| Customer master | client, account manager, contact |
| Coverage conditions | instructions in natural language |
Simulated data throughout. Book a call to see it on your own systems.
Related demos
Warranty claims resolution
A claims center where each incoming ticket is broken into its issues, mapped to the warranty line items that cover them with the page of the warranty document highlighted, clustered with resolved tickets to propose a solution, and explored as a network of ticket, issues, coverage and history.
Property insurance underwriting
An underwriting assistant for property submissions: broker emails and attachments extracted into a property record with every field sourced to the document, underwriting standards checked with external data and flagged, an AI scorecard against a chosen set of criteria with the PDF beside it, questions asked of the document, and a suggested response to the broker.
Portfolio risk trends and management
Portfolio steering for new business: gross premium, technical result, capital usage and loss against plan by policy segment and by corporate versus personal, the capital mix and new versus renewed business, a line of business view with rate and exposure trends, breach alerts on the plan, and macro trends from news, reports and meeting notes that trigger portfolio actions.