- Cycle time
- ↓ 30-50%
- Data entry
- ↓ 8 min saved/claim
- Extraction accuracy 95%+
Outcomes
Key Features
Fraud Signal Detection
ClaimVista analyzes every claim for fraud indicators, flagging suspicious patterns for SIU review. 50+ red flag rules detect late reporting, excessive treatment, prior claim history, and provider patterns. Duplicate detection identifies same loss reported across policies or carriers. Document authenticity analysis checks metadata and manipulation on photos and documents. Network analysis reveals connections between claimants, providers, and attorneys. Anomaly scoring flags claims outside normal patterns for loss type, geography, or policy segment. All fraud signals are logged with evidence for SIU investigation—no automatic denials.
Intelligent Document Processing
95%+ OCR accuracy on structured forms (FNOLs, police reports, repair estimates) and 90%+ on field photos. Extracts policy data, loss details, claimant information, and damage assessments. Supports Mitchell, CCC, and Audatex estimate formats. Low-confidence extractions are flagged for adjuster review with highlighted fields.
Auto-Triage & Routing
AI-powered claim classification by complexity, urgency, and fraud risk. Simple claims route to junior adjusters or straight-through processing. Complex claims escalate to senior staff. Fraud-flagged claims queue for SIU review. Configurable routing rules adapt to your team structure.
Flexible Automation Model
Straight-Through Processing (STP): 30-40% of simple, low-risk claims auto-adjudicated with zero human touch—validated data, no fraud flags, within policy limits. Human-in-the-Loop (HITL): Complex claims route to adjusters with 80% of data pre-extracted and validated. Average handling time drops from 45 minutes to 12 minutes per claim. Configurable thresholds let you dial automation up or down based on your risk appetite.
ClaimVista vs. Manual Claims Processing
| Capability | ClaimVista | Manual Process | Basic OCR Tools |
|---|---|---|---|
| FNOL Processing Time | < 3 minutes | 15-20 minutes | 8-10 minutes |
| Data Extraction Accuracy | 95%+ | Error-prone | 80-85% |
| Adjuster Pre-Fill | 80% of fields | None | Limited fields |
| Triage & Routing | Instant, AI-scored | Manual review | None |
| Fraud Detection | Real-time scoring | Post-facto review | None |
| Claims Platform Sync | Bi-directional | Manual entry | One-way |
| Audit Trail | Complete | Inconsistent | Limited |
Technical Specifications
What it does
- Auto-triage claims by complexity, fraud signals, and urgency
- OCR extraction of policy/loss data from photos, PDFs, and forms
- Pre-filled adjuster worksheets with validated data
- Fraud signal detection with 50+ red flag rules and SIU queue routing
- Integration with core claims systems (Guidewire, Duck Creek, etc.)
How it works
Intake
FNOL documents, photos, and forms arrive via any channel
Extract
AI extracts policy data, loss details, and damage information
Triage
Claims scored and routed by complexity, urgency, and fraud risk
Pre-Fill
Adjuster worksheets populated with verified data and recommendations
Sync
Claim data flows to your claims system with full audit trail
Intake
FNOL documents, photos, and forms arrive via any channel
Extract
AI extracts policy data, loss details, and damage information
Triage
Claims scored and routed by complexity, urgency, and fraud risk
Pre-Fill
Adjuster worksheets populated with verified data and recommendations
Sync
Claim data flows to your claims system with full audit trail
Built for Every Claims Line
Auto Claims
Challenge
High volume, damage photo review, estimate validation, subrogation recovery delays.
Solution
Photo AI extracts damage details and severity. Estimate import from Mitchell/CCC/Audatex with validation. Liability scoring accelerates subrogation recovery.
Property Claims
Challenge
CAT surge volume, contractor estimate variability, coverage verification bottlenecks.
Solution
Rapid FNOL intake during CAT events—scale instantly without adding headcount. Contractor estimate extraction. Coverage validation against policy terms.
Workers' Compensation
Challenge
Medical documentation complexity, treatment tracking, return-to-work coordination.
Solution
Medical record extraction and timeline automation. Treatment plan summarization. Reserve recommendations based on injury severity and historical outcomes.
Healthcare Claims
Challenge
CPT/ICD validation, medical necessity determination, provider documentation volume.
Solution
HIPAA-compliant processing with full audit trail. CPT/ICD code validation against submitted services. Medical record summarization for faster clinical review.
What you get
- Claims classifier model tuned to your loss types
- OCR pipeline for FNOL documents and field photos
- Adjuster dashboard with pre-filled worksheets
- KPI pack: cycle time, touchpoints, accuracy, fraud flags
- Claims system adapters (REST/SOAP)
Deployments & integrations
- Cloud or on-prem
- API integration with claims platforms
- Mobile-friendly adjuster interface
Security & governance
- HIPAA-compliant for healthcare claims
- SOC 2 Type II audited
- RBAC with adjuster/supervisor/SIU roles
- Full audit trail for regulatory compliance
Related
Products
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Frequently Asked Questions
Stop Typing. Start Adjusting.
ClaimVista handles the data entry so your adjusters can focus on claims
Or call us: +1-512-200-2416
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