Insurance Claims Management System

The claims lifecycle

Every claim follows a defined path: intake and FNOL, coverage validation against the policy, documentation and evidence capture, fraud and risk scoring, adjudication, and settlement with an accounting entry. Automating this path cuts cycle time and removes the manual hand-offs where leakage and errors occur.

How insurers automate claims

• Digital FNOL from the portal, mobile app, USSD or contact centre
• Automatic coverage and policy-status validation
• Fraud and risk scoring before payout
• Straight-through processing for low-risk claims
• Structured adjuster workflows for complex claims
• Automated claimant updates by SMS and WhatsApp

What is straight-through processing?

Straight-through processing (STP) means a claim is validated, assessed and settled automatically, without manual intervention, when it meets predefined rules — for example a low-value claim on an active policy with complete documentation and a low fraud score. STP improves customer experience while concentrating adjuster effort on the claims that need judgement.

How it works, step by step

1. First notice of lossClaim is logged digitally with policy, date and loss details.
2. Validate coverageSystem checks the policy is active and the loss is covered.
3. Score risk & fraudAutomated indicators flag anomalies for review.
4. AdjudicateSTP for low-risk claims; adjuster workflow for the rest.
5. SettlePayment issued and posted to the ledger with a full audit trail.

Business benefits

• Shorter claims cycle time and better customer experience
• Lower claims leakage through automated fraud controls
• Consistent, auditable adjudication decisions

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