AI-Powered Claims Processing That Actually Works
From document upload to a fully substantiated decision in under 2 minutes. Built for North American and European carriers who demand compliance, transparency, and results.
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Why Claims Handling Is Broken?
Your adjusters spend most of their time reading documents — scrolling through scans, cross-referencing policy language, chasing missing paperwork. The actual decision-making — the part that requires expertise and judgment — gets maybe 20% of their time. The other 80% is manual labor. While your team drowns in paperwork, policy holders wait, fraud slips through the cracks, and regulators raise the bar on what“transparent decision-making” really means.
Too Slow
The average claim takes a carrier 3–7 days to process. Policyholders expect same-day service. Every day of delay drives down NPS.
Too Risky
Manual review of every claim costs carriers an average of $50–$100. Fraud losses run into the millions. Add in hidden costs like rework and policyholder churn.
Too Expensive
Regulators demand explainable AI. Carriers must comply with GDPR in the EU and CCPA, state privacy laws, and NAIC Model Laws in the U.S. Full audit trails are a requirement, not an option.
How Does Automated Claims Processing Work?
We deploy intelligent automation that doesn’t just read documents — it understands context, verifies facts, and supports the adjuster in making error-free decisions.
1. Intelligent OCR
The system processes PDFs, photos, and handwritten notes with over 99% accuracy. The AI “sees” more — it can describe damage in photos (e.g., “water stains on ceiling”).
2. Contextual Analysis
AI doesn’t just search for keywords — it understands content. It independently extracts policy data, date of loss, and loss type, automatically classifying the submission.
3. Coverage Verification
The system instantly connects to the PAS (Policy Administration System). If coverage has lapsed or premiums are past due, the process stops immediately — without consuming adjuster time.
4. Special Conditions
AI locates and analyzes scanned endorsements or riders that may exist only on paper and were never entered into the core system. Nothing escapes its review.
5. Completeness Check
The system verifies that the claimant has submitted everything required for the specific claim type. If something is missing, it auto-generates a request for additional documentation.
6. Fraud Shield
Advanced metadata and EXIF analysis detects Photoshop manipulation, checks photo geolocation, and catches duplicate documents from serial claimants.
7. Policy Wording Validation
The AI agent searches the policy’s terms and conditions and pinpoints the exact clauses supporting approval or denial. Every decision is grounded in the policy language.
8. Claim Valuation
Product-specific algorithms (PA, Homeowners, Auto) automatically calculate the claim amount based on impairment schedules, medical fee schedules, and invoice verification.
9. Human-Controlled Decision
AI prepares a full recommendation and a draft correspondence letter to the claimant. The adjuster simply approves or edits the ready-made document. A human always has the final say.
Why Claims AI by Decerto?
We’re not building just another tool. We deliver a foundation that combines uncompromising security with the flexibility of cutting-edge AI models.
Compliance-First: Security Is Our Foundation
In the insurance world,regulatory compliance isn’t optional — it’s the baseline. Our architecture was designed to meet the most rigorous standards.
Global & State-Level Compliance: Full support for GDPR in the EU as well as CCPA, NYDFS Cybersecurity Regulation (23NYCRR 500), and other state-level privacy and insurance regulations in the U.S.
Data Sovereignty: Data stays where it belongs. We process European data in the EU and U.S. data domestically.
Full Auditability: Immutable, time-stamped logs allow you to reconstruct every step of the process — ready for DOI examinations and regulatory audits.
Human-in-the-Loop: AI supports, but a human makes the final call. Full control over the level of automation.
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Multi-Provider AI: No More Vendor Lock-In
We pick the best tool for each task, eliminating vendor lock-in risk.
Flexible Configuration: Switching providers is a simple config change, not a months-long code migration.
Built-In Failover: If one model goes down, the system automatically switches to an alternative, ensuring business continuity.
Insurance-Native DNA: We Understand Your Business
Claims AI was built by a team of experts who have spent 20 years implementing core insurance systems.
Domain Knowledge Baked In: We understand the nuances of policies, endorsements, and claims adjudication workflows better than any generic AI solution.
Agent Portal Experience: We leverage know-howgained from the largest core system implementations in the market.
Out-of-the-Box Integrations: The system connects instantly with your PAS (Policy Administration System) and financial/accounting platforms.
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Transparent ROI: See the Savings, Not Just the Costs
With us, you’re not buying a black box. Every process is measurable and quantifiable.
Full Cost Analytics: See the exact cost of handling each claim, broken down by OCR, analysis, and fraud detection.
Business Dashboards: Track time savings and system performance on a weekly and monthly basis.
Precision Scoring: Every submission receives a clear fraud-risk score, letting your adjusters focus where it matters most.
Stop Processing. Start Deciding.
Imagine a complex Personal Accident claim involving a rock-climbing injury, multiple medical invoices, and specialized policy endorsements. While a manual review would take hours, Claims AI completes the heavy lifting in just 90 seconds.
Our engine instantly executes high-precision OCR and image analysis, verifies coverage against the PAS, and deep-scans original policy documents to identify specific exclusions—like extreme sports clauses. Simultaneously, it runs a sophisticated fraud check, flagging edited EXIF metadata that the human eye might miss. The result? A fully valued $30,500 claim with a generated denial recommendation based on precise policy wording.
By the time the adjuster steps in, the entire case is ready for a final click. What used to be a half-day task is now a 5-minute closing, processed at a radical cost of just $0.05 per claim.
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How Does the Free POC Work?
You’re just four steps away from implementing AI in your business.
Customer Testimonials & References
See what leading insurers say about working with Decerto.
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