Machine learning in the adjudication path — with human review still in control — to move straightforward motor claims faster.
The situation
Every motor claim, simple or not, entered the same adjuster queue. Cycle times were slipping, and the carrier did not want a black-box that underwriters and legal could not explain. The PAS could not be ripped out.
What we did
- Sat with claims handlers for two weeks and documented the real decision points, not the process map on the wall.
- Integrated document intake and a scoring service in front of the existing claims system, with a confidence threshold the ops lead set.
- Routed only high-confidence, low-complexity claims to straight-through; everything else stayed with an adjuster, score attached.
- Logged every automated decision so SIU and audit could sample without a data science ticket.
What changed
- A meaningful share of first-notice motor claims now clears without sitting in the general queue.
- Handlers spend more time on the files that actually need judgment.
- Legal and SIU can see why a file was auto-routed, in language they accept.