Roughly two-thirds of clean claims now adjudicate straight-through, freeing adjusters for judgement work
Customer story
A top-10 North American P&C insurer
The carrier deployed Smart Claims with confidence-gated auto-adjudication, fraud and SIU scoring, and document intelligence for estimates and loss records — routing clean claims straight through while sending complex cases to specialists with the reasoning attached, all on a tamper-evident evidence chain.
A large multiline P&C carrier handled every claim through the same manual queue regardless of complexity, so straightforward claims waited behind complex ones and fraud was typically caught only after payment. Cycle times were long, leakage was high, and each decision was hard to reconstruct for disputes.
Illustrative outcome
68%
of clean claims now straight-through processed
- Smart Claims
- Customer 360
- Cortex AI
Illustrative and capability-framed — representative of platform capability, not a verified named-customer claim.
The challenge
A large multiline P&C carrier handled every claim through the same manual queue regardless of complexity, so straightforward claims waited behind complex ones and fraud was typically caught only after payment. Cycle times were long, leakage was high, and each decision was hard to reconstruct for disputes.
The solution
The carrier deployed Smart Claims with confidence-gated auto-adjudication, fraud and SIU scoring, and document intelligence for estimates and loss records — routing clean claims straight through while sending complex cases to specialists with the reasoning attached, all on a tamper-evident evidence chain.
The results
What changed
Illustrative, capability-framed outcomes from the modules deployed — representative of what the platform is built to deliver.
Average cycle time fell by more than two days as routine claims stopped queuing behind complex ones
Fraud is referred to SIU before payment using network and link analysis, reducing leakage
Every adjudication carries its inputs, model version and rationale for disputes and regulators
We stopped treating every claim the same. The clean ones clear themselves, and our adjusters spend their time where judgement actually matters.
Modules used
The platform behind the story
Each module deploys independently yet shares the same data fabric, Cortex brain and evidence ledger — explore the ones in this story.
Core Insurance
Smart Claims
Every decision on the file has an author, a rule and a record.
Explore Smart ClaimsDistribution & Customer
Customer 360
One view of every policyholder, household and interaction.
Explore Customer 360Analytics & AI
Cortex AI
AI that drafts and assists across insurance — but never decides ungoverned.
Explore Cortex AISee these outcomes on your world
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