Claims arrived as PDFs and emails in every format. Staff manually extracted fields, looked up policy data, and decided where each claim went. It was slow, inconsistent, and impossible to audit at volume — and the backlog grew every week.
A retrieval-grounded engine that reads each claim, extracts and validates the key fields, cross-checks live policy data, and routes it with a recommended action. Guardrails hold anything unusual for a human. It runs entirely inside the insurer's VPC.
First-touch triage dropped from hours to seconds. Around 60% of standard claims now flow straight through, staff focus on the genuine exceptions, and every decision is logged immutably for audit and rollback.
The engine reasons over the insurer's own documents and policy systems, so every extraction is grounded in real data — not guessed. Confidence thresholds decide what's safe to auto-route and what needs a human.
Critically, nothing happens silently. Each step — fields read, checks run, route chosen — is written to an immutable audit log the compliance team can inspect, and any decision can be reversed. That's what made an autonomous system acceptable in a regulated environment.
We're still on it: every exception a human resolves is fed back, so the engine handles more of the long tail each quarter.
"The backlog used to define our week. Now the engine clears the routine work overnight and our people only see what actually needs a human. And we can prove every decision."
— Claims Transformation Lead, national insurer (name withheld)