Triaging claims so adjusters focus on the complex ones

An insurance broker could use AI to read claim forms and supporting documents, route the simple cases for fast settlement, and flag the rest for human review.

Regional insurance broker A couple of months to value

The challenge

Adjusters spend a large share of their time on straightforward, low-value claims. The complex, high-value cases - where their judgement actually matters - get squeezed.

The approach

1Map the current claims intake and triage process.
2Use AI to extract structured data from claim forms, invoices, and supporting evidence.
3Score each claim for complexity and risk against firm-approved criteria.
4Route low-complexity claims for fast-track settlement; flag the rest for human review with a pre-written summary.

Potential outcome

Faster settlement for simple claims, improving customer experience.
Adjuster time concentrated on high-value, complex cases.
A clearer audit trail of how each claim was triaged.

Tools used

Document extraction AI Risk scoring model Claims management system

How a sensible pilot could look

The fastest way to test a use case like this is a tightly scoped 30-day pilot rather than an open-ended rollout. The shape we recommend in almost every UK SMB is the same: one workflow, one owner, one success metric, one decision date. The point is to learn quickly and cheaply, not to transform the business in month one.

In week one, map the current workflow end to end and time it. This baseline is non-negotiable - without it, you can't tell whether the AI made things better, worse, or about the same. In week two, set up the tool and train two or three people deeply rather than rolling it out widely. In week three, run the new workflow alongside the old one and capture friction in writing. In week four, review the data, decide go or no-go, and write up what you learned.

Even a no-go is a successful pilot if you understand why. The worst outcome is a 'maybe' that drags on for another month and quietly absorbs the budget.

What to watch out for

Picking too broad a workflow. Narrow it until it almost feels too small - you can always widen later.
Skipping the baseline. If you don't know what 'before' looked like, you'll argue about whether 'after' is better.
Removing the human review too early. Almost every successful AI rollout in an SMB keeps a person on the final decision for far longer than the vendor suggests.
Letting the success metric become a feeling. 'The team likes it' is not a metric. Time saved, error rate, response time, conversion - pick something measurable.
Pasting client or customer data into a public tool. Use the approved one, or don't paste it at all.

Questions worth asking before you start

Who owns this? Not a steering group - one named person whose job it is to make this work, with the authority to change the workflow rather than just observe it.
What does success look like in numbers? Pick one metric, write it down on day one, and don't change it mid-pilot.
What data is the AI allowed to see? Be explicit about what's in scope, what's out of scope, and where outputs are stored. Document it before the pilot starts, not after.
What happens at day 30? Diary the go / no-go meeting now. Invite the people who can actually decide, not just the people who'll be in the room anyway.

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