Claims & Adjudication

First-Notice-to-Settlement Claims Handling with Agentic AI

A claim arrives as a phone call, a form, a photograph and a stack of invoices, and every one of them has to be read before anyone can decide anything. Coverage has to be confirmed against the policy wording, the loss valued, the file checked for the patterns that indicate fraud, and the decision documented well enough to survive a complaint. Scalata's agentic AI platform reads the whole file, applies your own adjudication rules, and leaves an audit trail on every step.

Same-dayFirst-notice triage & coverage confirmation

AutomatedDocument, invoice & estimate extraction

Rule-basedAdjudication against your own policy wording

FullAudit trail on every decision and override

How it works

The four-step journey

The same shape every time: name what is going wrong, put the documents somewhere they can be read, let people ask questions of them, and then hand the repeating parts to agents that do not need asking.

01
Confronting Manual File Handling & Cycle-Time Pressure
Claims teams work files assembled from forms, correspondence, photographs, medical records and third-party estimates, most of it unstructured. Coverage checks are manual, valuations sit in spreadsheets, and cycle time is driven by how quickly a person can read. Leakage and inconsistent decisions follow.
Unstructured claim filesManual coverage checksInconsistent adjudicationCycle-time pressure
02
Building a Unified Claims Data Core
Every document attached to a claim is ingested and structured — the policy, the schedule, the endorsements, the invoices, the reports — and joined to the claim record so the file can be reasoned about as data rather than as attachments.
Document AIPolicy & endorsement parsingInvoice & estimate extractionMedical record structuring
03
Activating Intelligent Coverage & Valuation Analysis
Coverage is tested against the wording that actually applies, valuations are checked against comparable settlements, and the indicators your special investigations team already relies on are applied to every file rather than to a sample.
Conversational AICoverage position analysisValuation & reserve checksFraud indicator screening
04
Full Automation with Proactive Claims AI Agents
Straight-through files settle without a queue; the rest arrive at an adjuster with the coverage position, the valuation and the open questions already assembled. Agents chase missing documents and flag files drifting past service standards.
Straight-through settlementDocument chasingReserve movement alertsService-standard monitoringAI Agents

Strategic Outcome

Claims stop being paced by reading speed. Simple files close the day they arrive, complex files reach an adjuster already prepared, and every decision carries the wording it was based on — which is what turns a complaint or a regulatory review from an excavation into a lookup.

Who Scalata serves