Claims Triage & Assignment
Every new claim — triaged, enriched, and routed to the right adjuster in under 60 seconds. No manual review. No misroutes. Full audit trail.
Your claims team is the bottleneck they never asked to be
When a new claim comes in, someone has to read it, pull the policy, check the loss history, assess complexity, figure out who's available, assign it, and notify everyone. That process takes 15–30 minutes per claim — and your team handles dozens a day.
Meanwhile, the claimant is waiting. The adjuster doesn't have context. And your claims manager is spending their day on triage instead of the complex cases that actually need a human brain.
Most of this work is pattern recognition. It's rules-based. It's lookups. It's exactly the kind of work that AI was made for — if the AI actually understands insurance operations.
From FNOL to assigned — automatically
Intake
A new claim arrives — via web portal, email, voice, or agent submission. SectorFlow captures the FNOL data and creates the claim record.
Enrichment
The AI automatically pulls policy details, coverage limits, deductible, loss history, and account-level data. No manual lookups.
Triage
The AI assesses complexity based on configurable rules: estimate thresholds, prior claim patterns, coverage type, geographic risk, and key account status. Claims are classified as Low / Medium / High complexity.
Routing
Based on complexity, claim type, location, and adjuster availability, the AI recommends the best-fit adjuster. Workload balancing, specialty matching, and geographic proximity are all factored in.
Handoff
The assigned adjuster receives a complete claim package — policy summary, loss history, photos, triage assessment, and recommended next steps — in their Teams or Slack channel. The claimant receives an acknowledgment with their adjuster's contact info.
This isn't a chatbot — it's a claims operations engine
Every capability your claims team needs, built in from day one.
Policy & Coverage Lookup
Automatically pulls policy details, limits, deductibles, and exclusions from your policy admin system.
Loss History Analysis
Reviews prior claims on the policy and the claimant — flags repeat patterns and SIU triggers.
Complexity Scoring
Rules-based triage using your thresholds: dollar amount, claim type, geographic risk, account value.
Adjuster Matching
Matches claim to the best-fit adjuster by specialty, workload, geography, and availability.
SIU Flagging
Automatically flags claims that meet your Special Investigations Unit criteria — repeat claimants, threshold amounts, pattern anomalies.
Full Audit Trail
Every decision the AI makes — triage score, routing logic, data sources accessed — is logged and available for compliance review.
Connects to the systems you already run
Salesforce
ServiceNow
Microsoft Teams
Slack
Okta
Email (SMTP/Exchange)
Don't see your claims system? We integrate with any platform via API. Talk to us.
What carriers are seeing
Avg. triage time
Misroutes in pilot period
Reduction in manual triage work
Based on pilot deployments. Your results will depend on claim volume, complexity mix, and system configuration.
"We were spending 20+ minutes per claim just on triage and assignment. Now our adjusters get a complete package in under a minute. The AI flags things our manual process was missing — repeat claimant patterns, key account priority, SIU triggers. It's not replacing our team, it's giving them a head start on every claim."
— Claims Operations Director, Regional P&C Carrier
Frequently Asked Questions
See What 60-Second Triage Looks Like for Your Team
Book a 30-minute discovery call. We'll walk through the Claims Triage flow with your data and your rules.
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