ClaimWise · Insurance claims decisions
Every claim decided on the evidence.
ClaimWise reads every claim document, checks it against the policy, weighs the evidence and recommends the decision, with the reasoning attached. Your adjusters stay in control wherever your authority matrix says they should.
How it works
From arrival to action, every time.
- 01
Intake
Claims arrive from the portal, app, email or API. Bundles of forms, invoices, reports and photos are split and identified
- 02
Validate
Policy in force, peril covered, limits and claims used, and the insured item matched to the policy
- 03
Assess
Every claimed item weighed against the evidence: documents against each other, photos against estimates, values against benchmarks
- 04
Recommend
The payable amount calculated and the decision recommended, with its reasons, evidence and confidence
- 05
Route & settle
Straight through within authority limits, or to an adjuster with the full record. Settlement documents drafted and the claims system updated
Capabilities
What ClaimWise does.
Claim intake & classification
Claim forms, invoices, survey reports, estimates and photos split, identified and linked to the claim, whatever channel they arrive through.
Coverage validation
Policy status on the date of loss, perils and exclusions, limits and claims already used, all checked against the policy terms.
Cross-document reasoning
The claim form, invoice, survey and photos compared with one another. Where they disagree, your rules decide which source governs.
Evidence-backed assessment
Every claimed item has to be supported by evidence. Unsupported items are excluded, and the reason is recorded.
Valuation & payable calculation
Values drawn from invoices and benchmarks, checked against the sum insured, with deductibles and limits applied.
Fraud & risk signals
Duplicate claims, prior-claim history and inconsistencies across documents flagged before a recommendation is made.
Authority-aware routing
Straight-through where your authority matrix allows it. Adjuster sign-off for amounts above the limit, partial approvals or flagged claims.
Settlement preparation
Settlement letters, repair authorizations and customer notices drafted, and the claims system updated once the claim is approved.
Control & governance
The adjuster sees one screen of evidence, not a stack of documents.
Every recommendation arrives with its Decision Record: what was checked, what the evidence shows, what was excluded and why, which policy terms applied, and the confidence. Adjusters approve, adjust or reject in one place, and every determination is on the record for audit, disputes and regulators.
From claims to underwriting
The documents and context ClaimWise builds up for a line of business can carry into the next decision. Insurers start with claims and extend into underwriting on the same platform.
Integrations available today
- Microsoft Outlook & OneDrive
- Google Drive
- Jira
- DocuSign
- APIs
Connect your ERP, core banking, claims or CRM system through APIs.
Deploy your way
As SaaS, or ring-fenced inside your own environment: any major cloud, private cloud or on-premises. Bring your own LLM.
- SOC 2
- ISO 27001
- HIPAA
- GDPR
Your data never trains our models.
Proof
A leading general insurer: marine claims from 28 days to 2 days.
Claims intake, validation and adjudication across 200,000 claims a year, live in production across marine, extended warranty, and accidental and liquid damage lines.