AI Claims Pipeline for Insurance

The Challenge

SecureLife Insurance processed 500+ claims monthly, with each claim taking an average of 7 days from submission to payout. Their claims team manually reviewed documents, extracted data from forms, verified information, and detected potential fraud. The process was slow, error-prone, and frustrating for customers waiting for payouts.

The claims manager needed an AI solution that could automate document processing, flag suspicious claims, and accelerate legitimate payouts while maintaining accuracy and compliance.

Our Solution

We built an intelligent AI claims pipeline that automated the entire claims workflow:

• •OCR document processing using AWS Textract to extract data from forms and supporting documents
• •NLP-powered claim analysis using OpenAI to understand claim narratives and identify inconsistencies
• •Automated fraud detection algorithms scoring claims based on risk factors
• •Intelligent routing system directing claims to appropriate adjusters
• •Real-time status dashboard for customers and claims team

Python handled the AI processing and business logic, with PostgreSQL storing structured claim data. A React frontend provided intuitive interfaces for both customers and claims adjusters.

The Results

The impact exceeded expectations. Average processing time dropped from 7 days to just 2.5 days (a 65% reduction). The system achieved 98% accuracy in data extraction, eliminating manual entry errors that previously caused delays.

Claims processed per day increased by 150%, allowing the same team to handle significantly more volume. Customer satisfaction scores improved by 40%, with policyholders praising the faster payouts and transparent status updates. The company saved approximately $75K monthly in operational costs while delivering superior service.

Want similar results? Book a discovery call with Quenlix.