Every claim moved at the

The Challenge

A short-term insurer writing personal auto and household cover ran a claims operation where every claim followed one path: intake, manual triage, adjuster review, approval. The adjusters were competent and busy; the queue was the constraint. The work was being done properly — it was simply being done in the wrong order. A diagnostic found three compounding causes.

1. One queue for every claim. No segmentation by risk or complexity, so a simple claim inherited the wait of the hardest claim ahead of it.
2. Triage and fraud checks done by hand. Eligibility, policy and fraud checks ran sequentially, by a person, even where the answer was never in doubt.
3. Customers chased the process. With no automated status updates, “where is my claim?” calls consumed the very adjusters causing the backlog.

The Solution

• Segment at intake : Claims land in Salesforce and are scored on risk and complexity the moment they arrive — before anyone touches them.
• Let the simple ones clear themselves : Low-risk claims passing every policy, eligibility and fraud gate auto-approve end to end. Anything flagged routes to an adjuster with the evidence attached.
• Keep the customer informed : Automated status updates at every stage, so adjusters work claims instead of answering calls about them.

The Impact

The win wasn't a faster form. It was the simple claims clearing themselves — so people could work the hard ones.