Insurance USE CASE
Inside a Leading European Insurance Company's FNOL Transformation
THE PROBLEM
Claims management is one of the most manual, costly, and time-intensive operations in insurance.
Hours-long manual triage
Handlers move each claim across systems one by one. At peak times, triage alone can take hours before a file is ready for an adjuster.
Back-and-forth on every file
Backlogs and rising costs
Funders stop at the first error and send packages back. Dealers fix, resubmit, hit new errors. Days lost per round-trip.
RPA is not built for this
Black-box AI has no audit trail
Customer experience suffers
The Claims Lifecycle: From First Notice to Settlement.
Every insurance company runs claims a little differently. But across the four main stages, wherever the manual work concentrates, that is where time-to-resolution goes up and the process becomes expensive.
First Notice of Loss
What makes it slow
- Manual claim capture across phone, email, and portal.
- Claim details copied across systems manually.
- Identity, policy, and coverage checked one document at a time.
Investigation
What makes it slow
- Chasing missing documents back from the customer.
- Manual cross-referencing of police reports and third-party data.
- Fraud signals reviewed case by case.
Assessment & Adjudication
What makes it slow
- Damage and liability reviewed manually, often by different adjusters.
- Settlement calculation done outside the system.
- Files routed back and forth for review and re-review.
Payment & Resolution
What makes it slow
- Disbursement readiness checked manually across systems.
- Customer communication drafted case by case.
- Recovery and subrogation tracked outside the core platform.
THE SOLUTION
A Digital Worker built specifically for FNOL.
Before Maisa
How the claim process used to be managed.
- Claims sat in a queue until a handler picked them up.
- Details were transferred across systems manually from email, phone, and portal.
- Identity, policy, and coverage were checked one document at a time.
- Files were returned to the customer whenever something was missing.
- Cases were opened in the CMS manually, often inconsistently.
- Adjusters picked up files where triage had barely started.
Four to five hours per claim
After the Digital Worker took over
How Julian manages the claim now.
- Receives the claim through any channel, with photographs, police reports, and supporting documents.
- Reads, classifies, and fully understands all information provided.
- Confirms no duplicate case exists for the same customer and policy.
- Validates coverage against live policy data.
- Creates the case directly in the legacy CMS, uploads a detailed PDF report, and attaches all documentation.
- Adjuster opens a complete, validated, fully traceable file.
A few minutes per claim
In production at a leading European insurance company, FNOL responses now happen before a human has touched the file.
THE OUTCOME
Clear ROI, measured in production volume.
53% Faster claims processing
Intake and triage that used to take hours now complete in minutes, around the clock, across every incoming channel.
20 to 30% Reduction in claim handling cost
Manual hours move out of intake and into the higher-judgment work where adjusters add the most value.
98% Straight-through processing
Nearly every claim moves from first contact to a fully validated case file with no human in the loop
58,000+ Hours returned to higher-value work annually
Adjusters spend their day on the complex cases that need judgment, not on triage and data entry.
24/7 Availability across all incoming channels
Claims reported overnight, weekends, or holidays are triaged in real time. No queue. No delay until business hours.
100% auditable Every claim decision
Every case file includes a full chain of work: checks run, sources queried, signals fired, and the reasoning behind the final decision.
Why Maisa
Hallucination-Resistant
- Maisa’s KPU (Knowledge Processing Unit) sits on top of any large language model and converts predictions into deterministic, rule-based execution.
- Every output is predictable, consistent, and safe for production use in a regulated environment.
Built for industries where one wrong output is one too many.
Trust and Auditability
- Full chain of work for every decision, including data used, checks run, and reasoning applied.
- Audit trails are auto-generated. Compliant with GDPR, the EU AI Act, US Banking, SEC, and HIPAA from day one.
Predictable Pricing
- Priced like headcount, not API calls. No surprise token bills or usage spikes.
- ROI calculable before contracts are signed, with the business case built and validated before deployment.
LLM-Agnostic and Self-Healing
- Runs on any large language model with no vendor lock-in. Gets smarter as models improve.
- When something unexpected happens, the Digital Worker adapts and continues. No silent failures.
Onboard your first Digital Worker today