Claims management is often associated with slow, time-consuming, and error-prone processes. But it doesn’t have to be.
Clive, the insurance industry’s first AI Claims Adjuster, is the modern answer to outdated claims processes.
Clive enhances any existing Claims Management System (CMS) with advanced AI and automation, instantly improving efficiency, accuracy, and decision-making. He ensures claims are processed faster, more accurately, and in full compliance—without requiring insurers to overhaul their technology stack.
Clive doesn’t just process claims—he understands them. Unlike traditional claims software that simply records data, Clive combines multiple AI models (compound AI) that orchestrate claims handling with unparalleled speed and automation.
These are the models that Clive is built on, that propel his a data-based, end-to-end claims handling:
You wouldn’t spend an hour washing dishes by hand when you could use a dishwasher. So why should adjusters waste time on repetitive, administrative, and manual tasks when AI can handle them instantly?
Automation-first means that anything that can be automated, will be. The result is reduced cycle times and claim leakage, nearly zero human errors and happier adjusters and claimants.
Clive automates every step of the claim process, allowing for manual oversight as needed, in line with the insurer’s Standard Operating Procedures (SOPs):
Analyzes claim severity, assigns the right adjuster, or handles low-complexity claims autonomously.
Cross-checks policies, past claims, and external data sources to determine coverage eligibility instantly.
Automatically calculates reserves based on claim severity, policy coverage, and historical payout data.
Recommends the most suitable vendors, analyzes invoices, and triggers automated payments.
Ensures every claim follows standardized workflows, compliance rules, and audit requirements.
Suggests the next best action, helping adjusters make data-based and faster decisions.
Drafts policyholder updates, adjuster reports, and legal notices in real time, reducing administrative work.
Uses AI to flag suspicious claims based on historical patterns, external data, and behavioral analysis.
Identifies opportunities for subrogation and flags relevant claims for further investigation.
Automatically extracts key details from documents, emails, and images, organizing them for easy access.
Clive’s solid API framework allows seamless integration with any CMS, policy admin system, payment processor, or third-party data provider.
Clive integrates with medical billing databases, vendor networks, and compliance systems, ensuring a smooth, interconnected claims process.
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