What insurance intake automation means

Insurance intake automation completes the file before a person reviews it. It does not settle the claim. It does not decide coverage. It does not replace the adjuster or underwriter.

The intake starts when a claimant, broker, agent, or policyholder sends information. The intake ends when the reviewer has the facts, evidence, checks, and open questions in one case file.

Where the work breaks

A form can collect answers. A portal can collect files. A claims system can store the case. The hard work sits between those tools.

• The same fact appears in several documents.
• A required page is missing.
• Two dates do not agree.
• A photo or scan is not readable.
• The policy number does not match the current record.
• The claimant does not know what evidence to send next.

If the intake stops at upload, the adjuster must solve each problem. The file reached the system, but the intake is not complete.

Use Form. Fact. Verify.

Form

Build the guided intake for one claim or submission type. Ask for the answers and documents that this workflow needs. Change the next question when an earlier answer changes the evidence list.

Fact

Define the facts that the reviewer needs. A fact can be an incident date, policy number, claimed amount, vehicle registration, address, or document validity date.

Each document-derived fact must point to its source. The reviewer must be able to open the document and read the passage behind the value.

Verify

Run the checks that support intake. Compare facts with other facts. Call the policy system or another customer system that the workflow uses. Show the result to the reviewer.

A failed check is not a claim decision. It is a visible result that the reviewer must assess.

Ask while the applicant is present

Do not wait for the adjuster to find every gap. Ask the claimant or broker for the missing item during intake when possible.

The request must be clear. Name the document or answer. Explain what is wrong. Do not expose an internal verification result or an internal fraud rule.

Keep the decision with the reviewer

The agent can prepare the file. The adjuster or underwriter must make the regulated judgment.

Keep these actions outside the intake agent:

• accept or deny coverage;
• set liability;
• set a reserve;
• decide fraud;
• price a risk;
• settle a claim.

Start with one workflow

Do not start with every product and claim type. Pick one repeated intake with a clear document list and a named reviewer.

1. Choose one claim or submission type.
2. List the required answers and evidence.
3. Define the facts that the reviewer needs.
4. Define the checks that support intake.
5. Run test cases with complete and incomplete files.
6. Review every citation and follow-up question.
7. Measure the time to a review-ready file.

Measure the intake, not the model

Use operational measures:

• time from first submission to review-ready;
• operator touch time per case;
• number of applicant follow-ups;
• missing items found before review;
• document facts with valid source citations.

Do not ask a model for an accuracy or confidence score. Review the evidence and measure the work.

See the Klarefi insurance workflow

The insurance intake page shows how Klarefi collects, resolves, clarifies, and hands off the file.