Key takeaways
- H2O Driverless AI can be used to build claim triage models from your own claim, policy and payment history, with reason codes on every score.
- Low-risk claims can move to fast-track payment, while complex or suspect claims route to an adjuster or investigator with the reasons attached.
- Reason codes on a denial tell the adjuster what to check and the policyholder what is missing, so a claim can be corrected and resubmitted.
- An agent can assemble a claim file, read the report, photos and policy coverage, and draft a recommendation for the adjuster to approve.
Give every policyholder a fast, explainable answer
A policyholder who has just had an accident or a burst pipe learns what your promise means when they file. They want a fast and fair answer, and every extra day or unexplained request wears down the relationship.
Most claims queues still run on rules and manual review. Your adjusters open the same systems for a routine claim as for a complex one, and the rules cannot tell which claim needs a closer look. Denials add their own work: when a claim is denied or returned, you need a documented reason a policyholder, a complaint reviewer or an examiner can follow.