ClaimsIQ 

by KPI Partners

GenAI Accelerator for Intelligent Insurance Adjudication.

Overview

ClaimsIQ is a GenAI-powered accelerator designed to streamline the end-to-end insurance claims lifecycle. By ingesting and analyzing a diverse array of unstructured data, including policy documents, legal reports, and photographic evidence. ClaimsIQ provides a 360-degree view of every case. It eliminates the bottleneck of manual document verification, allowing claims adjusters to focus on high-value decision-making rather than data collation.

The ROI of ClaimsIQ

Significant Reduction in LAE (Loss Adjustment Expense)

By automating the document-heavy "triage" and verification phases, ClaimsIQ reduces the administrative cost per claim by up to 40%.

Mitigation of Claims Leakage

The RAG-based reasoning engine identifies subtle inconsistencies between policy documents, police reports, and photographic evidence, preventing overpayments and identifying potential fraud before settlement.

Exponential Adjuster Productivity

Instead of spending hours collating and reading through diverse files, adjusters can use the "Interactive Assistant" to find answers in seconds. This allows existing teams to manage a 3x higher case volume without increasing headcount.

Accelerated "First Notice of Loss" (FNOL) to Settlement

Shortening the claims lifecycle from weeks to days directly impacts customer satisfaction, leading to higher policy renewal rates and improved Net Promoter Scores (NPS).

Data-Driven Decision Integrity

Move from "gut-feel" or "spot-check" adjudication to 100% evidence-based recommendations, ensuring every claim is handled with consistent, auditable accuracy.

Business 

Use Cases

1 Cross-reference claimant IDs, policy details, and police reports to ensure consistency and authenticity (Automated Claim Verification).

2 Analyze images from accident sites to corroborate verbal descriptions and assess damage severity (Accident Scene Reconstruction).

3 Generate concise, actionable summaries of complex cases involving dozens of individual files (Multi-Document Case Summarization).

4 Enable agents to query specific documents (e.g., "What was the specific weather condition mentioned in the police report?") using a RAG-based interface (Interactive Adjuster Assistant).

5 Automatically identify discrepancies or missing documentation that may indicate potential "leakage" or fraudulent activity (Fraud Detection & Red- Flagging).

Underlying Technology

Multi-Modal Ingestion Layer

Capable of processing structured text (IDs), unstructured text (Police Reports), and visual data (Accident Site Images).

RAG Reasoning Engine

A Retrieval-Augmented Generation framework that grounds AI responses in the specific documents of each unique claim, preventing hallucinations.

Intelligent Vision & Document AI

Extracts critical data points from scanned documents and analyzes photographic evidence for automated damage assessment.

Unified Agent Interface

A secure dashboard where adjusters can view AI-generated recommendations and interact with the case data in real-time

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Success Snapshot

Faster Claims, Better Outcomes: AI in Accident Coverage

Challenges

A leading insurer faced a 15-day turnaround time for accident claims.
Manual review of multiple document types (policy, ID, police reports, images) slowed processing.

Solution

Deployed ClaimsIQ to analyze claims data across documents and images.
Automated summarization and key information extraction.
Enabled faster, AI-driven claims processing.

Results

Reduced triage time with instant summaries and document verification.
Improved accuracy and adjuster productivity with faster access to claim details.
Accelerated claim settlement through streamlined processing.

AI Engagement Model

Industry-Wide Applicability

Processing accident claims with image-based damage assessment.
Reconciling medical bills with policy coverage and physician notes.
Assessing home or business damage through site photos and inspector reports.
Analyzing large sets of evidence to provide case recommendations for disputed claims.
Managing high volumes of complex, multi-layered policy documentation.

Success Stories

Reduced claims turnaround using AI-driven workflow automation, improving speed and consistency across operations.

Global Financial Services Leader

Enabled self-service access to ERP and analytics using governed GenAI, reducing IT dependency and improving decision speed.

Leading U.S. Beverage Manufacturer

Improved reliability through predictive intelligence and root-cause analysis embedded into operational workflows.

Global Manufacturing Leader

Data Platform Migration for Modern Analytics

KPI DataBridge Suite is designed to help enterprises modernize their data and analytics infrastructure across:

BI Modernization 🔗
Data Platform Migration 🔗
Data Products 🔗