Blog · AutoClaims
Why every claim payout should need two people, however fast the claim moves.
Speed and control are often presented as a trade-off in claims. We think the payout is the one step where you should never trade.
As claims operations automate, there is a natural pull towards straight-through settlement: a claim comes in, the documents are read, the rules say it is fine, and the money goes out with nobody touching it. For some tiny, low-risk claims, insurers may decide that is acceptable under their own policy. As a default, we think it is the wrong design.
Our position is simple. Automate everything up to the payout as far as your rules allow. At the payout, require a maker and a checker, both human, both recorded.
The payout is the irreversible step
Almost everything in a claim can be corrected. A misread document can be re-read. A wrong triage route can be changed. A customer update can be followed by a correction. Money that has left the account is different. Recovering an incorrect payout is slow, expensive and often unsuccessful, and it damages the relationship with a customer who may have done nothing wrong.
That asymmetry is the whole argument. Put the strongest control at the step that cannot be undone.
Leakage is found after payout when controls sit in the wrong place
Many claims teams describe the same frustration: suspicious claims are identified after they have been paid. That usually means the checks that would have caught them ran too late, or ran by queue rather than by rule. Triage that applies your investigation rules on arrival, with the reason recorded, moves the warning earlier. The maker-checker step then makes sure a person has seen that warning before money moves.
The two work together. Rules flag; people decide.
Two people does not have to mean slow
The usual objection is that a second approval adds delay. It does when the checker receives a bare request and has to rebuild the file to understand it. It does not when the checker receives:
- The claim, with documents already read and structured.
- The policy checks: cover, waiting periods and limits.
- The triage route and the reason for it.
- Any leakage flags, with the rule that raised them.
- The maker’s note on what was approved and why.
With that in front of them, a checker can confirm a clean fast-track claim in moments and spend real time only where the flags point. The delay that hurts customers is rarely the second signature. It is the days of missing documents and manual re-keying before it.
The audit log is the point, not the paperwork
Every payout decision should leave a record: who made it, who checked it, what they saw, which rules fired. That record protects the customer when a decision is questioned, protects the adjuster who acted in good faith, and gives managers the evidence to improve the rules. A process in which software pays claims without a named person attached gives you none of that. For specific regulatory or audit requirements in your market, confirm with your compliance adviser.
Where automation belongs
| Step | Automated | Person |
|---|---|---|
| First notice of loss | Yes, on WhatsApp or portal | For complex cases |
| Document reading and policy checks | Yes | Reviews exceptions |
| Triage | Yes, by your rules, with the reason | Adjusters review triage decisions |
| Customer updates | Yes, every step | Grievances |
| Payout | No | Maker and checker, always |
How we built it
AutoClaims follows this split. Intake, document reading, policy checks, triage by your rules and status updates are automated; payouts are approved by people under maker-checker and written through your APIs, with one audit log for every decision. When a line goes live, adjusters review every triage decision. For how the rules themselves are set, see our claims triage rules guide and the comparison of manual and rules-based triage. More in the AutoClaims guides.
Questions
What is maker-checker in claims?
A control in which one person prepares or approves a payout and a second person checks it before money moves, with both actions recorded.
Does maker-checker slow down claim settlement?
Not much, if the checker receives the read documents, policy checks, triage reason and flags with the request. Most delay comes earlier, from missing documents and re-keying.
Should any claims be paid without a person?
We think human approval should be the default for payouts. Any exception is a decision for the insurer under its own policy and regulatory advice.
See it on your own data. AutoClaims — Claims without the status calls. Book a 30-minute working session with an engineer.