Claims automation
Automated insurance claims your adjusters can trustbuilt on the tools you already use.
Automated claims processing uses AI to read claim documents and photos, check them against the policy and route each claim. Adjusters keep the complex ones. We build it for carriers, MGAs and TPAs.
30 minutes. You leave knowing which 3 processes to automate first and what they cost you today.
Example based on our insurance case
Trusted by companies worldwide
Trusted by companies worldwide: Braffess, Casa Sors, HollaBoo, Laoom, Guardian Development Group
Results
Claims processed 75% faster.
Same approach as every build: start with the process that costs the most, then measure what changes.
Insurance
Claims processed 75% faster.
A regional insurer's adjusters spent 70% of their time on routine claims, so every claim took 15 days. We built an AI that reads the documents and photos, checks the policy and recommends a decision, so adjusters only handle the complex cases.
600+hours back every month99.5%decision accuracy+30%capacity, no new hires
The problem
Every claim is read by hand.
-6%
Projected decline in claims adjuster, appraiser, examiner and investigator jobs, 2025 to 2035.
389,700
Claims adjusters, appraisers, examiners and investigators held about this many U.S. jobs in 2025.
21,600
Average yearly openings projected for these roles over the decade.
Adjusters spend their days opening documents and photos and matching them to policies. The workforce is shrinking, so manual handling gets harder to sustain.
- Manual claims handling: Adjusters open every document and photo to start each file.With claims process automation: The documents and photos are read first, with a summary waiting for the adjuster.
- Manual claims handling: Coverage is checked claim by claim against the policy.With claims process automation: The claim is checked against the policy and a decision is recommended with its reasons.
- Manual claims handling: Simple and complex claims wait in the same queue.With claims process automation: Straightforward claims are routed on, and complex ones go to an adjuster.
- Manual claims handling: Notes about why a decision was made live in people's heads.With claims process automation: Each step is logged, so every decision can be reviewed later.
Adjusters keep the judgment calls, the system does the reading.
What we automate
How AI claims processing works, step by step.
First notice of loss
Capture the claim from email, forms or calls and open a complete file.
Document and photo reading
Read claim documents and photos and pull out the key details.
Coverage check
Compare the loss against the policy and flag what applies.
Triage
Sort claims by complexity so each one reaches the right queue.
Decision recommendation
Draft a recommended decision with the reasons behind it, for an adjuster to review.
Complex claims to adjusters
Send complex or sensitive claims to an adjuster with full context.
Is it time?
Signs you need claims processing automation.
Signals you need this
- Adjusters spend most of their time reading files, not deciding
- Straightforward claims wait behind complex ones
- Coverage checks vary from one adjuster to the next
- Hiring more adjusters is the only way to handle more claims
When not to invest yet
- You handle only a few claims a month
- Your claims come with no documents or photos to read
- You have no written claims process to build from
What you get
From the first claim to a live system.
- A map of your claims process, with the hours and dollars each step costs you
- A fixed-price proposal with exact scope and timeline, before anything starts
- Claims AI that reads documents and photos and checks them against the policy
- Automated claims management that moves straightforward claims on and sends complex ones to adjusters
- Recommendations your adjusters review, so the judgment calls stay with them
- Testing end to end before launch, and training for your claims team
- Code, accounts, prompts and data that stay yours
How it works
The Payback Loop. Five steps. Each build pays for the next.
We don't start with the AI. We start with the money.
Consulting
We find the manual work in your company and how many hours each task eats every week.
Process mapConsulting
We put a dollar figure on each process and rank them by payback. You see what to automate first, and what to leave alone.
AI roadmap, ranked by paybackImplementation
We build the first system on the tools you already use. Nothing new for your team to learn.
A working systemImplementation
We test it end to end before launch. It doesn't go live until it works without errors.
Tested, system liveSupport
The first build pays back fastest, so its savings fund the next one. Back to the map, and we keep every system running.
Monthly support (optional)
↺ Back to Map
Consultancies stop at the roadmap. Freelancers build without one. The loop only works when one team runs all five. You approve, we execute: about an hour a week from you.
FAQ
Questions about automated claims.
- Automated claims processing uses AI to read claim documents and photos, check them against the policy and route each claim, so adjusters handle only the complex cases.
- No. The system does the reading and checking, while adjusters keep complex and sensitive claims and the final calls. The BLS expects technology to automate some adjuster tasks, such as estimating damage from photos.
- A regional insurer we built for processes claims 75% faster, with 600+ hours back every month and 30% more capacity with no new hires. Your result depends on your claims mix.
- Claim documents and photos are where the system starts: it reads them, checks the details against the policy and recommends a decision. In our insurance case, decision accuracy is 99.5%.
- RPA for claims processing follows fixed rules on structured data. An AI system can also read documents and photos, compare them with the policy and recommend a decision, while adjusters keep the complex claims.
- Yes. The NAIC model bulletin expects insurers to keep a written program for AI systems used across the insurance life cycle, including claim administration. AI-supported decisions must comply with insurance laws.
- Your claims system stays. We build on the tools you already use, such as your inbox, CRM and phone, so adjusters keep working from the screens they know.
- The roadmap takes 1 to 2 weeks. Your first claims workflow is usually live in 14 to 21 days, and a full system takes 6 to 8 weeks, all scoped in a fixed-price proposal.
Final step
Pick a time. Let's talk.
You leave knowing which processes to automate first and what each one costs you today, whether we work together or not.
You can keep paying for manual work, or find out this week exactly what it costs you.
What happens on the call
Before
You answer 3 quick questions when you book, so we come prepared.
On the call
We find the manual work that costs you most and put a number on it, live.
Decide
An honest read on whether we're the right fit. If we're not, you'll hear it on the call.
Once you book, we look at your site and tools before the call, so the 30 minutes go to your numbers, not introductions.
Prefer to write first? Email us directly: contact@nexumautomations.com