ClaimRelay replaces the spreadsheets, phone tag, and manual processes that slow your claims operation. Here is everything it does.
ClaimRelay accepts claims through any channel — web portal, email, phone, or mobile app. The AI extracts all relevant details from unstructured submissions: policy number, date of loss, damage description, location, and contact information. It validates coverage against the policy, identifies the claim type, and creates a fully structured record ready for processing.
Policyholders can attach photos, videos, and documents during submission. ClaimRelay automatically categorizes attachments and links them to the appropriate sections of the claim file. No manual data entry required.
Accept claims via web portal, email, phone transcription, or mobile app. Every channel feeds into the same structured workflow.
AI cross-references the claim against the policyholder's coverage, deductibles, and policy limits before the claim enters the pipeline.
Photos, receipts, police reports, and contractor estimates are automatically categorized and attached to the correct claim sections.
ClaimRelay identifies potential duplicate submissions by matching policyholder, date of loss, and claim details against existing records.
ClaimRelay analyzes submitted photos, descriptions, and documentation to generate preliminary damage estimates within minutes of intake. The AI model is trained on millions of historical claims across property, auto, and casualty lines to provide accurate cost projections.
For straightforward claims — minor auto damage, small property repairs, standard replacement items — the AI estimate is often sufficient for settlement. Complex or high-value claims are flagged for field inspection with the AI assessment included as a starting reference for the adjuster.
Computer vision analyzes damage photos to identify damage type, severity, and affected areas. Works for property damage, vehicle damage, and personal property.
Generates repair and replacement cost estimates based on local market data, contractor rates, and materials pricing. Updated monthly for accuracy.
Automatically classifies claims as minor, moderate, or major. Minor claims can be fast-tracked while major claims get immediate adjuster attention.
When field inspection is needed, ClaimRelay schedules it automatically based on adjuster availability, location proximity, and claim priority.
Every claim processed by ClaimRelay passes through a multi-layered fraud detection engine. Machine learning models analyze claim patterns, cross-reference historical data, and score each claim for fraud risk. High-risk claims are flagged for special investigation before any payment is authorized.
The system catches common fraud patterns — duplicate claims filed across carriers, inflated damage estimates, staged losses, claims filed shortly after coverage increases — and emerging patterns that rule-based systems miss. False positive rates are kept low to avoid delaying legitimate claims.
ML models identify suspicious claim patterns across your book of business: unusual claim frequency, atypical damage-to-premium ratios, and geographic clustering.
Claims are checked against industry fraud databases, prior claim history, and public records. Connections between claimants, contractors, and witnesses are mapped.
AI examines submitted documents for signs of alteration, inconsistent metadata, recycled photos, and mismatched timestamps.
Every claim receives a fraud risk score from 0 to 100. Adjusters see the score, contributing factors, and recommended next steps at a glance.
ClaimRelay automatically assigns claims to adjusters based on a weighted scoring model that considers expertise match, geographic proximity, current caseload, claim complexity, and adjuster performance history. No more manual spreadsheet assignments or manager bottlenecks.
When workloads spike — after a catastrophe event or during seasonal peaks — ClaimRelay automatically rebalances assignments and can route overflow to your network of independent adjusters or TPA partners.
Claims are matched to adjusters by line of business expertise (property, auto, liability, workers comp), certification level, and language capabilities.
Real-time caseload monitoring ensures no adjuster is overwhelmed while others are underutilized. Automatic rebalancing when assignments change.
For claims requiring field inspection, ClaimRelay routes to the nearest qualified adjuster. Minimizes travel time and gets inspections done faster.
During CAT events, ClaimRelay activates surge protocols: priority queuing, automatic escalation, and overflow routing to partner adjusting firms.
The number one complaint policyholders have about the claims process is lack of communication. ClaimRelay solves this by sending proactive, personalized updates at every stage of the claims lifecycle. Policyholders know what is happening without having to call in.
AI handles routine policyholder questions — "What is my claim status?" "When will the adjuster visit?" "What documents do you still need?" — freeing your staff to focus on complex interactions that require human judgment and empathy.
Automated notifications at each milestone: claim received, assessment complete, adjuster assigned, inspection scheduled, settlement approved, payment sent.
Updates sent via email, SMS, or portal notification based on policyholder preference. All communications logged in the claim file.
Policyholders can ask questions about their claim via chat or email. AI responds with accurate, claim-specific information drawn from the live claim record.
When additional documentation is needed, ClaimRelay sends targeted requests with clear instructions and a secure upload link. Follow-ups are automated.
For claims that meet predefined criteria — under a certain dollar threshold, clean fraud score, matching coverage, and complete documentation — ClaimRelay can calculate the settlement amount, generate an approval recommendation, and initiate payment processing with minimal human intervention.
Complex or high-value claims receive a detailed AI analysis package that includes the damage assessment, comparable claim data, settlement range recommendation, and all supporting documentation, giving adjusters everything they need to make a fast, well-informed decision.
Configure dollar thresholds, claim types, and fraud score limits for automatic settlement. Full audit trail for every auto-approved claim.
AI calculates settlement amounts based on damage assessment, policy terms, deductibles, depreciation schedules, and applicable state regulations.
Approved settlements trigger automatic payment via ACH, check, or direct deposit. Policyholders are notified immediately with payment details.
Every settlement is validated against state regulatory requirements, policy terms, and internal authority limits before approval. Non-compliant settlements are escalated.
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