Compare
Manual claims handling vs rules-based triage and WhatsApp intake.
Most claims teams already have rules. They live in experienced adjusters’ heads, which is why the same claim is handled differently on different days.
| Area | Manual: calls, forms and queues | Rules-based triage with WhatsApp intake |
|---|---|---|
| Registration | Call centre and forms | WhatsApp or portal, documents read on arrival |
| Policy checks | Looked up by hand | Cover, waiting periods and limits checked against the policy |
| Triage | By queue, by whoever is free | Fast track, standard or investigate by your rules, with the reason |
| Leakage | Often found after payout | Flagged before payout |
| Status | Customers call to ask | Pushed at every step |
| Payout | Approved by people | Approved by people, maker-checker |
| Renewals | Email and a last-minute call | Worked by segment, early |
What stays with people
- Assessment where judgement is needed.
- Investigation of flagged claims.
- Every payout approval.
- Grievances and sensitive conversations.
Where to start
Pick one line of business with high volume and a clear status-call problem. Write down the rules adjusters already use, run them alongside adjusters who review every triage decision, and extend once the rules hold. Read claims triage rules.
How AutoClaims does it
AutoClaims is built for general and health insurers and their TPAs. Customers register a claim on WhatsApp or the portal; photos, bills, discharge summaries and FIRs are read and structured on arrival; cover, waiting periods and limits are checked against the policy. Each claim is triaged by your rules into fast track, standard or investigate, with the reason, and suspicious ones are flagged before payout. Garages, hospitals and surveyors are booked, every step is pushed to the customer, and payouts are approved by people under maker-checker and written through your APIs. Renewals are worked by segment, early, with payment links on WhatsApp. Adjusters and investigators keep every judgement that needs a person.
Questions
What is rules-based claims triage?
Applying written rules on cover, value, completeness, timing and history to send each claim to fast track, standard or investigate, with the reason recorded.
Does claims automation replace adjusters?
No. It handles intake, document reading, rules and status messages; adjusters and investigators keep the judgements and people approve payouts.
See it on your own data. AutoClaims — Claims without the status calls. Book a 30-minute working session with an engineer.