How insurers use decision intelligence to automate routine claims, prioritize complex cases, and cut turnaround time, without losing oversight.
Most claims teams still triage and route manually. Simple claims wait behind complex ones, fraud indicators are missed, and turnaround stretches for days, driving up cost and frustrating customers exactly when experience matters most.
Claims are the moment of truth for an insurer. Faster, more consistent decisions lower loss-adjustment expense, improve retention, and free skilled handlers to focus on the cases that genuinely need judgment.
Score every incoming claim by complexity and risk the moment it lands.
Straight-through process low-risk claims; route the rest to the right handler.
Flag anomalies for SIU before payout, with evidence for investigators.
Extract structured data from forms, photos, and PDFs automatically.
Estimate exposure early to support reserving and prioritization.
Generate concise case summaries so decisions are faster and consistent.
Quantify the opportunity and pick one line of business to pilot.
Deploy triage and routing on a single claim type with a holdout.
Track turnaround, workload, and fraud catch against the holdout.
Expand across lines and add document AI and severity prediction.
A focused pilot on one claim type typically shows turnaround and workload improvement within the first processing cycle, with full ROI visible after a holdout comparison.
No. OKEMA reads from your existing claims platform and writes triage, routing, and recommendations back into the queues your handlers already use.
It automates clearly routine, low-risk claims and routes everything else to handlers with decision support. Complex and high-risk claims always stay with people.
Historical claims with outcomes, policy details, claim documents, and handler decisions are enough to build and validate the first models.
Run the numbers in two minutes, or book a call to map the highest-value first project.