AI employees for TPAs and loss adjusters,
working in your claims system
Replace manual human work with AI employees that open the file, check the policy,
book the visit, chase the documents and draft the report. Your adjusters still decide.
Before we start
You need a claims system. We work inside it.
Our AI employees are not software you install. They log in to the system you already use, the same way a new hire would. Guidewire, Duck Creek, Sapiens, Origami, FileTrac, XactAnalysis or your own build. We do not replace it.
Claims
Diary
Documents
Payments
Reports
Claims / FL-2481133
FL-2481133
OpenMeridian Property LLCFile notes
Claim opened from broker FNOL
IntakePolicy
HO-4471902
Cause
Escape of water
Reserve
41,500
Adjuster
J. Okonjo
Signed in as a user you made, with the access you gave it
- They work in your system, so the file stays where it is
- They follow your rules, carrier by carrier
- Every action is saved as a file note
- No migration and no second system to check
If you run claims on email and spreadsheets
Then we are the wrong call today, and we will say so on the first call. Get a claims system in first. There is nothing for our people to work inside until you do.
The work
Four AI employees. Here is what each one does.
Whether you handle the claim end to end for a carrier or get instructed on single losses, this is the same work. Each AI employee owns a job from start to finish, and stops for a person when your rules say it should.
Broker FNOL
23:41
Policy
Insured
Date of loss
Cause
Address
01
Opens the claim
A broker emails an FNOL at midnight. It reads the email, finds the policy and opens a clean claim before your team gets in.
- Fills in the insured, the date of loss and the cause, using your codes
- Checks it is not a duplicate of a file you already have open
- Emails the broker for whatever is missing, the same hour
Policy term
Escape of water, covered
Mould, sub-limit applies
Wear and tear, excluded
Indemnity reserve
Expense reserve
From 38 similar closed claims
02
Checks cover and sets the reserve
It reads the policy against the loss and puts a draft position and a reserve recommendation in front of your adjuster. The adjuster signs it, not the AI.
- Checks the policy was in force on the date of loss
- Pulls out the deductible, the sub-limits and any exclusion worth a look
- Suggests a reserve from your own closed claims that look like this one
Diary run
128 files done before 08:00Acknowledgement due, day 3 of 15
Estimate late, 9 days
Carrier update due today
No movement, 21 days
03
Works the diary every morning
It goes through every open file before your team sits down, sends what is due and chases what is late.
- Sends acknowledgements and status updates on the day they are due
- Chases insureds, brokers and contractors until the document arrives
- Tells the team leader which files have not moved in weeks
Adjuster report
From 14 photos and the site notes
Contractor estimate
Strip out and dry, 3 rooms
1,840
Laminate, 42 m2
3,960
Scaffold, 2 weeks
1,250
Skip hire
380
04
Drafts the report, checks the bill
It writes the first draft of the survey report from the site photos and your notes, in the format that carrier wants, then reads the estimate line by line.
- Drafts the report so your adjuster corrects it instead of writing it
- Flags estimate lines outside the agreed scope or over your rates
- Catches invoices already paid, or over what you approved
Also
The rest of the paperwork
Small jobs, every file, all day.
Files the documents
Names every photo, report and invoice your way and attaches it to the right claim.
Recovery check
Police report
Scene photos
Witness details
Third party at fault
Spots recovery
Reads each new claim for a subrogation or salvage angle and saves the proof while it is still there.
Checking numbers
Builds carrier reports
Makes each carrier's monthly pack in their format and checks it against your own numbers first.
Site visit
Tue 09:00
Tue 14:30
Wed 11:00
Slots offered to insured
Books the site visit
Offers the insured a slot, confirms it, and puts the appointment in the adjuster's diary with the address and the contact.
Fee events
Claim opened
45
Site visit done
180
File closed
95
Billable
0
Captures your fees
Records fee events, time and expenses as the work happens, on your fee scale, so you invoice for what your team did.
Closing checks
Reserve zeroed
Documents complete
Recovery noted
Final report missing
Checks files before closing
Runs your closing checklist and sends the file back to the handler if something is missing.
What changes
What you get back
We will not quote you a percentage before we have read your files. These are the six places the money shows up.
Speed
Claims close sooner
Files are opened and chased the day they arrive, not when someone gets to them.
Capacity
More files per adjuster
Take the paperwork off the desk and the same team carries more claims.
Leakage
You stop paying twice
Every bill and every estimate gets read, not a sample of them.
Service
Audits go better
Deadlines are met and the proof is already sitting in the file.
Surge
Storms without hiring
A cat event doubles the claims, not the headcount you need.
Fees
You bill what you did
Fee events and time are captured as the work happens, not from memory at month end.
Control
Your rules, not ours
Hard limits, not settings someone can switch off in a hurry.
The adjuster decides
Cover, denials, reserves and payments stay with your licensed people. The AI prepares the work. It does not sign it.
It all goes in the file
Every action is a file note in your system, with the name of the AI employee that did it.
One program at a time
It only sees the programs you give it, with the limits and templates the carrier agreed.
It stops when unsure
Anything odd, or over its limit, goes to a person with the reason written down.
Start
How we begin
One program, real files, a number you can check.
- 01
Two weeks with your team
We read your files and count where the handling time goes. You keep the findings either way.
- 02
One carrier first
One program, one AI employee. Small enough to prove in a quarter.
- 03
It works your real files
In your system, next to your team, with someone on your side who can switch it off.
- 04
Then the rest
If the numbers hold, the same setup goes to your other programs.
What's the bottleneck holding you back?
Let's talk about the constraints limiting your growth and how we can eliminate them.