AI pre-screening handles the paperwork so adjusters can focus on the cases that need human judgment
Average claims processing time had ballooned to 34 days. Customer satisfaction scores were at a 5-year low. Three senior adjusters retired in Q1, and the company couldn't fill the positions — experienced insurance adjusters were demanding $95K+ and getting multiple offers. The backlog was growing by 200 claims per week.
This Newport Beach-based life insurance company processed 45,000 claims annually with a team of 28 adjusters. Each claim required document verification, policy cross-referencing, medical record review, and compliance checks. Junior adjusters made errors that required senior review, creating bottlenecks. The company had tried outsourcing to a BPO — quality dropped so badly they pulled back within 6 months.
We built an AI claims pre-screening system that automatically extracts data from submitted documents (OCR + NLP), cross-references against policy terms, flags inconsistencies, and routes claims to the appropriate adjuster tier based on complexity. Simple claims (40% of volume) are auto-processed with human spot-checks. Our overnight team handles document processing for claims submitted after 5 PM, so adjusters start each morning with pre-screened, organized case files.
I was terrified the AI would replace my team. Instead, it replaced the parts of their job they hated. My best adjusters are finally doing the work they were trained for — evaluating complex cases, not chasing missing paperwork.— Claims Operations Manager
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