Insurance Claims Processor

Insurance Claims Processor

Process, analyze, and optimize insurance claims. Covers property, liability, workers' comp, auto, and professional indemnity.

What This Does

Takes raw claim details and produces:

Structured claim summary with policy coverage mapping

Liability assessment with supporting/weakening factors

Reserve estimate with confidence range

Subrogation opportunity analysis

Red flag detection (fraud indicators, coverage gaps)

Settlement recommendation with negotiation range

Regulatory compliance checklist by jurisdiction

Usage

Provide claim details in any format — adjuster notes, policyholder statement, incident report, photos, or free text. The agent structures everything.

Quick Claim Analysis

Analyze this claim: [paste details]

Full Processing

Process claim for:
Policy type: [commercial general liability / property / WC / auto / PI]
Incident date: [date]
Reported date: [date]
Claimant: [name/entity]
Description: [what happened]
Claimed amount: [if known]
Policy limits: [if known]
Jurisdiction: [state/country]

Claim Analysis Framework

1. Coverage Determination

Map incident to policy provisions

Identify applicable endorsements and exclusions

Flag coverage disputes early

Check occurrence vs claims-made triggers

2. Liability Assessment

Score 1-10 on insured liability exposure:

1-3: Strong defense position, deny or minimal settlement

4-6: Mixed liability, negotiate

7-10: Clear insured liability, reserve and settle

Factors evaluated:

Comparative/contributory negligence (jurisdiction-specific)

Statutory obligations

Contractual indemnity provisions

Prior loss history pattern

3. Reserve Estimation

Three-point estimate:

Low: Best case with strong defense

Mid: Most likely outcome

High: Worst case including litigation costs

Include:

Indemnity reserve

Defense costs (inside/outside limits)

Allocated loss adjustment expense (ALAE)

Unallocated loss adjustment expense (ULAE)

4. Fraud Detection

Red flags scored by severity:

Claim timing patterns (Monday morning, policy inception proximity)

Prior claim frequency

Documentation inconsistencies

Witness availability issues

Financial stress indicators

Description vs damage inconsistency

5. Subrogation Analysis

Third-party recovery potential

Evidence preservation requirements

Statute of limitations by jurisdiction

Cost-benefit of pursuit

6. Settlement Strategy

Opening position and authority range

Mediation vs litigation cost comparison

Jurisdiction-specific verdict ranges

Structured settlement considerations for large claims

Industry-Specific Modules

Property Claims

Replacement cost vs actual cash value

Business interruption calculations (gross earnings, extra expense)

Ordinance or law coverage triggers

Catastrophe event coordination

Workers' Compensation

Compensability determination

Return-to-work timeline

Medical treatment guidelines by state

Permanent disability rating estimates

Professional Liability

Discovery rule and statute of repose

Prior acts coverage analysis

Consent to settle provisions

Panel counsel selection criteria

Auto/Fleet

Comparative fault allocation

UM/UIM stacking analysis

Medical payment coordination

Total loss threshold calculations

Compliance Checklist Generator

Produces jurisdiction-specific compliance timeline:

Acknowledgment deadlines

Investigation completion requirements

Payment timing obligations

Required notices and disclosures

Bad faith exposure triggers

Output Format

Every analysis produces: 1. Executive Summary — 3-line claim snapshot 2. Coverage Analysis — provisions, exclusions, disputes 3. Liability Score — 1-10 with reasoning 4. Reserve Recommendation — low/mid/high with breakdown 5. Red Flags — fraud indicators if any 6. Action Items — next steps with deadlines 7. Settlement Range — if applicable

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Provide claim details in any format — adjuster notes, policyholder statement, incident report, photos, or free text. The agent structures everything.

Quick Claim Analysis

Analyze this claim: [paste details]

Full Processing

Process claim for:
Policy type: [commercial general liability / property / WC / auto / PI]
Incident date: [date]
Reported date: [date]
Claimant: [name/entity]
Description: [what happened]
Claimed amount: [if known]
Policy limits: [if known]
Jurisdiction: [state/country]