UC-387
FNOL Triage & Claim Complexity Routing
Reads each loss notification against the policy wording, grades complexity and routes the claim to fast-track, adjuster or investigation.
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The Challenge
Simple claims queue behind total losses, so cycle time and leakage both rise while the customer waits. Triage rules are hand-written, rarely revisited and cannot read a photograph or a free-text loss note.
How It Works
- Reads the loss notification, incident photographs, policy schedule and wording at first touch.
- Grades severity, cover certainty and fraud signal, then matches the claim to handler skill.
- Routes the claim within minutes and tells the handler what evidence is still outstanding.
What It Removes
- Manual reading of every loss description at intake
- Reassigning claims after the wrong handler opens them
- Chasing policy wording to confirm cover at first touch
Input Data RequirementsFNOL forms and call transcripts, incident photographs, policy schedules and wordings, claims records, handler skill matrix, historical claim outcomes
Output FormatRouted claim with a complexity grade, cover-certainty flag, reserve suggestion and the evidence still required from the customer
“Our worst outcomes are the small claims that sat in the wrong queue for three weeks before anyone read the wording.”