As a reinsurer, you play a vital role in managing risk, ensuring capital efficiency, and stabilizing the insurance market. But to do this effectively, you need clear visibility into claims, accurate loss tracking, and seamless recoveries from primary insurers. Without the right technology, reinsurance claims oversight becomes slow, manual, and prone to disputes and errors.
Five Sigma’s AI technology is designed to simplify reinsurance claims operations, providing real-time data, automated reinsurance recoveries, and deep insights into the contract and portfolio performance.
With Five Sigma, you gain full visibility into claims across multiple cedents and the ability to analyze, track, and manage exposures and recoveries effectively.
Driving this efficiency is Clive™, the insurance industry’s first AI Claims Adjuster.
Clive works on top of the Five Sigma claims management platform (CMS) or any other existing CMS, adding advanced AI capabilities that automate and accelerate claims handling by reinsurers.
Clive offers dynamic oversight by continuously analyzing inbound claim data, identifying key risks, matching claims to treaties, and surfacing opportunities for faster recoveries.
He can detect anomalies, assist with complex claim validation, improve accuracy, and streamline reinsurance workflows – on top of any CMS.
Recovering funds from primary insurers is often a manual, fragmented process, leading to delays, disputes, and inconsistencies in reinsurance recoverables.
With insurers using different claims systems and reporting formats, it’s difficult to track outstanding recoveries efficiently, increasing administrative burden and financial uncertainty.
Direct control over claims handling typically begins only once a claim crosses a certain threshold, making real-time alerts and centralized data aggregation essential.
In the absence of a single, structured source of claims data across multiple cedents, assessing exposure, tracking loss development, and understanding the financial impact of catastrophes becomes difficult.
Brokers often use inconsistent data formats, varying structures, and different coding systems, making it challenging to streamline and automate claim processing. These discrepancies require insurers to manually interpret and map data, leading to delays and potential errors.
Additionally, differences in terminology and contract structures further complicate claims reconciliation. Incoming data needs to be accurately processed and recoveries precisely calculated to prevent unnecessary payouts and maintain accuracy in reporting and underwriting.
Complex reinsurance claims, especially those involving lengthy medical records, expert reports, and legal documents—pose a significant challenge in reinsurance. These claims require extensive document review, cross-referencing, and interpretation, often leading to delays and inconsistencies in claim assessment.
The sheer volume of information makes it difficult to extract key details, identify relevant precedents, and ensure compliance with policy terms. Without efficient tools, adjusters must manually sift through large datasets, increasing the risk of errors and inefficiencies.
Bringing Clarity and Speed to Reinsurance Claims Handling
Clive automatically processes inbound broker data, enabling format unification (e.g., standardizing Bordereaux reports) and data-driven claim routing based on policy terms and historical data. Clive also helps overcome format discrepancies, such as when a broker incorrectly reports an update as a new claim, ensuring accurate claim matching, CAT code standardization, and aligning broker-reported codes with industry conventions for better claims reconciliation.
Clive consolidates claims data from multiple cedents into a single platform, eliminating data silos, ensuring a structured, real-time view of claims data.
With all relevant claims information in one place, tracking loss development, assessing financial impact, and making informed decisions is faster and more efficient.
Clive automates calculation and tracking of advised and impacted layers, reducing reliance on manual processes that can cause delays and disputes. He provides a clear view of outstanding reserves, payments, and reinsurance obligations, enabling faster, more accurate reimbursements and improves financial reconciliation between cedents and reinsurers.
Clive categorizes and tracks claims by treaty type, whether quota share, excess-of-loss, or facultative reinsurance. He automates validation against reinsurance agreements, ensuring compliance with contract terms and preventing overreserving, overpayments, or incorrect recoveries.
Clive maintains a comprehensive audit trail, logging all claims transactions, communications, and decisions to ensure full compliance with IFRS 17, Solvency II, and NAIC requirements. He automates regulatory reporting, eliminating the burden of manual tracking, and ensuring reinsurers have structured, transparent, and easily accessible claims data for audits and compliance checks.
Clive uses advanced data modeling and predictive analytics to transform raw claims data into actionable insights, supporting risk exposure assessment, loss reserve optimization, and improved financial planning. Clive enables proactive trend identification, anomaly detection, and data-driven decision-making to minimize losses and maximize profitability.
Sounds too good to be true? Schedule a demo and see for yourself!
Five Sigma’s AI-native, automation-first approach is making reinsurance claims management review simple and efficient. With Clive and Five Sigma’s claims management platform, reinsurers gain full visibility into their processes, ensuring that every claim is tracked, validated, and reconciled with precision.
Reinsurance operations demand accuracy, speed, and transparency—Five Sigma provides the technology to make it happen. Request a demo to see how.
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