Orchestrates Which incoming claims should be fast-tracked vs held for full manual triage?
Claims Intake Triage
Strategic workflow diagnosis
- Purpose
- Get each incoming claim to the right handler quickly and consistently.
- Owner
- Claims Operations Manager
- Trigger
- A new claim is submitted via the policyholder portal or phone intake.
- AI options considered
- Use the existing Claims Leakage & Fraud Risk Scoring signal to pre-sort at intake, rather than only downstream.
- Human roles involved
- The duty officer still makes the final call on anything flagged as uncertain and on all high-value claims.
- Current state
- A duty officer manually reads every claim and decides where it goes; the existing leakage/fraud signal isn't used at intake, only later in processing.
- Future state
- Claims are automatically pre-sorted using the existing leakage/fraud signal; the duty officer reviews only what it flags as uncertain.
Information assets involved
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