ClaimsRAG: Automating Complex Claims Management

How insurers accelerate claims resolution without errors

The real challenge: Reviewing a complex claim requires analyzing the policy, technical report, customer communications, and insurance laws. This manual process takes an average of 45 days, generates delays, customer dissatisfaction, and increases operational costs.

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The Insurance Sector's Bottleneck

Reviewing a complex claim requires analyzing the policy, the adjuster's report, customer communications, and often the Insurance Contract Act. This manual process generates delays, increases customer dissatisfaction, and raises the operational costs of the broker or insurer.

The Key Insight

Insurers who automate claims triage with AI reduce resolution time from 45 to 7 days. Fraud is detected in 48 hours versus 3–4 weeks with manual processes.

ClaimsRAG: Speed Without Error

With Igera Finance, we transform the workflow. The system "reads" the client's specific policy and technical report, and prepares a resolution proposal based strictly on the contracted coverages.

• Instant Coverage Analysis: The system identifies whether an event is covered or excluded, citing the exact clause.
• Inconsistency Detection: Finds contradictions between the insured's account and the adjuster's technical report.
• Customer Communication: Drafts clear, well-reasoned communication, dramatically improving transparency.

Pro-tip: Fraud patterns detected by AI in 48 hours versus 3–4 weeks with manual analysis can save thousands of euros per case.

"We have dramatically reduced file closure times. AI gives us the foundation; our managers make the final decision with all the information on the table."

About the author

Joan Puig

Operations Lead, Igera Solutions

Insurance process automation specialist with over 8 years in the sector. His experience spans claims management at multinational companies to workflow optimization at small brokerages.

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