Use cases/Financial services/Claims triage
AI claims triage for Australian insurers
Claims triage means every first notice of loss reaches the claims system as one record, whichever channel it came from. The system sets the line of business and severity, lists the documents still missing and drafts the next letter with its due date. The claims officer decides every claim.
Talk to our team →- Supports
- Claims officer
- Reads
- Claim emails, Web forms, PDF attachments, Call notes, Policy records
- Runs on
- Your servers, on premises
- Connects to
- Guidewire, WinBEAT, Sunrise Exchange, Steadfast INSIGHT
- Decides
- A person, every time
Architecture
Everything runs on your servers
We build it on an open-weight model such as Llama or Mistral, served with vLLM on NVIDIA GPUs in your own environment. Intake runs through Kafka or your mailbox integration, classification is tested with pytest and Ragas style evaluation, and records are written back to the claims platform you already run.
- SourcesClaim emails / Web forms / PDF attachments / Call notes / Policy records
- Your serversMerge every channel → Set line and severity → Check Code timeframes
- ReviewClaims officer
- OutputOne record from every channel / Line and severity / Missing document checklist / Letters with due dates
It takes four jobs off the claims officer
- 01
One record from every channel
Email, web form, PDF and call notes are read into a single claim record. The record is checked against the policy and routed to the owning team with a summary.
- 02
Line and severity
Each claim is classified by line of business and by how serious it looks. The reason sits beside the label, so an officer can see why it went to a queue.
- 03
Missing document checklist
The documents a claim type needs are compared with what arrived. The gap is listed for the officer and in the request to the customer or broker.
- 04
Letters with due dates
Acknowledgements, information requests and updates are drafted from the claim file. Each shows the due date against the General Insurance Code of Practice timeframes.
It goes live in five steps
- Step 01
Collect past claims by channel
Closed claims as they first arrived, with the line of business, the queue and the documents requested. This is the test set and it decides the design.
- Step 02
Write down the triage rules
We sit with the claims officers and list how they sort a claim and which documents each type needs. The rules are written down and encoded.
- Step 03
Test against closed claims
The system classifies claims that already have a queue and an outcome. The labels are compared with the officer decisions, and the results set which claim types go first.
- Step 04
Run in shadow
Officers sort claims as usual while the system classifies beside them. They mark each miss, and those marks feed the evaluation set.
- Step 05
Officer reviews and decides
Records and letters reach the officer for review. Every claim decision and every letter sent stays with a person, and the log records each classification and each decision.
Software or a custom build
Guidewire already carries claims workflow for insurers. Broking systems such as WinBEAT carry the client and policy record, and Sunrise Exchange moves quotes and policy transactions between brokers and insurers. Steadfast INSIGHT carries the client record for Steadfast brokers. It became Steadfast Apps in September 2026. The Steadfast Client Trading Platform handles quoting and is now reached through Steadfast Apps. Use the intake and letter features in your claims platform first if claims arrive through one channel in a fixed format. A custom build earns its cost when claims arrive through several channels, when triage rules sit in people's heads, or when claim documents cannot leave your environment.
Guidewire / WinBEAT / Sunrise Exchange / Steadfast INSIGHT / Steadfast Client Trading Platform / Salesforce / SharePoint
In practice
We build this on servers the insurer owns. The model, the claim index and the logs sit inside your environment, and policyholder data is not sent to a public AI service. The retrieval pattern is covered in RAG on private infrastructure, and the build falls under AI agents and workflow automation.
An example engagement shows how we run first notice of loss intake for a general insurer, with a classifier for line of business and severity and a checklist of missing documents written back to the claims system. The log records each classification and each decision.
The deadlines come from the General Insurance Code of Practice. An insurer that needs more information asks for it within 10 business days of receiving the claim. The decision follows within 10 business days of the insurer having all relevant information and finishing its enquiries, and the Code sets an outer limit of 4 months from receiving the claim. The system shows those dates and a person sends the letter. The wider picture for insurance has its own page.
Questions
What is AI claims triage?
It is the sorting and drafting that happens before an assessor reads a claim. The system reads each first notice of loss, sets the line and severity, lists missing documents and drafts the correspondence. The claims officer decides the claim.
Does the AI decide whether a claim is paid?
No. The claims officer makes every claim decision. The system classifies, lists what is missing and drafts letters for approval. Anything it is unsure of goes to one queue with the reason attached.
How does it handle the Code of Practice timeframes?
It shows the due date beside each draft letter, set from the General Insurance Code of Practice timeframes. A claims officer approves every letter before it goes. Your compliance team confirms how the timeframes apply to each claim.
We already run Guidewire or a broking system such as WinBEAT. Do we need to change?
No. We build beside the system you already run, reading from it and writing back to it. It stays the system of record.
Industries where this comes up
More financial services use cases
Document search / Credit file assembly / AML alert triage / Month-end close / Audit evidence matching / Advice file drafting / Lease abstraction / KYC and onboarding / Complaints handling / Regulatory reporting / Underwriting submissions / Board and management reporting
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