Platform Health · Life · P&C · Disability · LTC · Travel

Claims, from FNOL to payment.

One claim operating system for every line — with AI triage, fraud scoring, straight-through processing and a single payment ledger.

Explore capabilities
Every line, one workflow

The whole claim lifecycle, on one stack.

From first notice to final payment, from clean claim to complex litigation — our claim system handles the full range, at scale, across every line of business.

01

FNOL & intake

Omnichannel first notice — phone, portal, app, email, text, partner API. Auto-coverage lookup and assignment.

02

Straight-through

70%+ of clean claims adjudicated without human touch. Deterministic rules with AI triage of exceptions.

03

Fraud detection

Real-time ML scoring, SIU referral workflows, cross-claim network analysis and anomaly detection.

04

Workflow & assignment

Skill-based routing, diary management, supervisor queues, reassignment rules and performance tracking.

05

Payments

ACH, check, virtual card and digital wallet disbursement. Tax reporting, lien handling, reserve management.

06

Regulatory

State prompt-pay, unfair-claims practices, prompt-contact and documentation-timeline compliance enforced automatically.

AI claim triage

Humans handle the complex. Software handles the rest.

Every incoming claim is scored the moment it arrives — for coverage, severity, fraud risk and complexity. Clean claims go straight through. Complex claims get the right adjuster in seconds.

  • Severity. Predictive severity and reserve recommendations on intake.
  • Fraud. Real-time fraud scoring with SIU routing for high-score claims.
  • Routing. Auto-assignment by line of business, geography, complexity and adjuster skill.
  • Diary. Intelligent diary suggestions, auto-closing closed loops, never a missed callback.
  • Litigation. Outside-counsel portal, legal-bill review and litigation management built in.
By the numbers

Real numbers from real deployments.

70%
Clean-claim straight-through processing rate
$0.38
Cost per adjudicated claim at steady state
95%
Fraud detection rate on ML-flagged claims
<24 h
From FNOL to first-payment on simple claims
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