AI CLAIMS MANAGEMENT AND SUBROGATION FOR INSURERS
HOW IT WORKS
01
Start from the prebuilt agent
It already knows submissions, ACORD forms, loss runs, endorsements, filings, reserves and claim files, and the checks your teams run on them.
02
Configure it to your tools, systems and parameters
We connect Guidewire, your document store, the broker inbox, ISO ClaimSearch and filings, and load your appetite, authority levels and approval chain.
03
Release it into the work
It starts on live work. Our platform checks every draft against its source and stops where a licensed person must approve.
04
It works like a trained member of your team
Work arrives ranked and drafted, source cited. Underwriters, compliance and adjusters sign, and nothing binds, pays or files without sign-off.
OUR PLATFORM
Your appetite, authority levels, audit standard and approval chain, plus what your underwriters and adjusters know, written down as the playbook the agent follows.
Every tool connected where it sits, one account per insured, and every figure traced to the document, page and line it came from.
Every draft is checked against its source and your rules, and the agent stops where a licensed person has to approve.
It sees only what the person it works for can see, and every step is logged.
THE SYSTEMS IT READS
PolicyCenter, ClaimCenter and BillingCenter
Scanned policy files, endorsements, correspondence
Submissions arriving as email with attachments
Standardised applications and supplements
Prior carrier history, usually as a scan
Industry claim history and match results
Firmographics, credit and sanctions screening
Fault, causation and treatment evidence
What was found and agreed
Rate and form filings by line and state
Signed applications and endorsements
In-house systems, mainframe extracts, flat files
FAQ
Nothing re-reads a claim once it is reserved unless the number moves. The fault finding on page three is never wrong, just never read again.
No. It comes prebuilt for claim file review and is configured to your claims system and recovery rules. It reads the file itself, so no new data is needed.
Subrogation is the one recovery that expires. Once the limitation period passes the money is gone, so every finding is dated and the queue ranked by value against time left.
Do we need a data team to run this?
No. We connect your systems, configure the agent to your rules and run the layer underneath it. Your team reviews and approves the agent’s work; nobody has to build or maintain data pipelines.
Do we have to move our data into a new warehouse first?
No. The agent works across the systems you already run, through a governed context layer that keeps every figure traced to the record it came from. If you already have a warehouse, it becomes one more source.
Why not build this ourselves?
You can, and for some teams it is the right call. The build is rarely the hard part. Resolving the same claim, policy and claimant across systems, keeping definitions consistent and getting the team to use it every week is where internal projects stall. We take that on so your engineers do not become platform operators.
What are your security and compliance standards?
OutcomeCatalyst is HIPAA-aligned and SOC 2 Type 2 aligned, with the formal audit underway and expected to complete before year-end.
RELATED READING
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