ClaimsAssist AI, Sorts Claims, Drafts the Reply
Sorts incoming insurance claims, checks them against the policy, and drafts the reply letter for an adjuster to check and send.
When a claim comes in, someone has to work out what type it is, whether the policy covers it, and write back. That took days. This gets it down to hours.
The problem
- A new claim can sit two days before anyone even assigns it
- Checking cover against the policy wording is slow, careful work
- Reply letters get written from scratch every time, so quality wanders
- Customers are left waiting and chasing
How it works
The claim and its paperwork come in. The tool works out what kind of claim it is, checks it against the policy, and drafts the reply.
Clear-cut cases get routed automatically. Anything borderline goes to a senior adjuster. Either way a person reads the letter, edits it, and sends it. Nothing goes out unsigned.
What it does
Lisa runs claims for a regional insurer. Getting from a new claim to a first reply took two days.
Now claims are sorted as they arrive, and adjusters get a draft letter instead of a blank page. Time from claim to first reply dropped by 35%. Letters read consistently, which the legal team prefers. They later added appeal drafts for health claims.
Where it fits
- Insurers: a thousand claims a day sorted and checked before an adjuster opens them
- Adjusters: a draft letter to edit, saving about half the time
- Health plans: consistent, compliant denial and appeal letters
Built with: Claude, connections into policy and claims systems. It drafts and sorts. It does not give legal advice, and every letter is signed by a person.
Interested in building something like this?
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