Background
The insurer received claim information through several channels, including email, portals, uploaded files, and existing claims tools. Information could arrive in various formats and at varying levels of completeness.
Adjusters spent part of their time collecting documents, checking required information, and preparing files before substantive claim review could begin. Operations managers also had limited visibility into which cases were complete, where work was accumulating, and which actions remained pending.
The modernization effort focused on creating a structured intake process that prepared claims consistently before they moved further into handling.
Approach to solution
Computools began by mapping intake, documentation, triage, and adjuster preparation workflows with business stakeholders. The team identified where information entered the process, which documents and fields were required, how cases were assigned, and where manual work accumulated.
A role-based workflow was then designed around a clear sequence: first notice, document intake, data extraction, completeness validation, triage, routing, queue placement, and status tracking.
Document classification and structured data capture reduced manual preparation. Completeness checks highlighted missing information before the case moved forward.
Routing logic used claim type, complexity, urgency, and adjuster expertise to direct cases to the appropriate queue.
REST-based integrations connected the platform with claims, policy, CRM, and document management systems. Dashboards and audit trails gave operational teams a consolidated view of case status, workload, and action history.
Computools role
Computools was responsible for:
- mapping claims intake and preparation workflows;
- defining user roles and operational responsibilities;
- designing FNOL and document intake flows;
- implementing document classification and structured data capture;
- configuring missing-information and completeness checks;
- defining triage and routing logic;
- integrating claims, policy, CRM, and document systems;
- creating role-based dashboards and claims queues;
- implementing action history and audit trails;
- supporting operational reporting and case-status visibility.
Key decisions and outcomes
Computools made case readiness a visible part of the workflow, allowing claims teams to confirm whether required documents and information were available before a file reached adjuster review. AI-supported classification, data extraction, completeness checks, and triage reduced manual preparation while final claim decisions remained with authorized insurance teams.
Routing logic was built around claim type, urgency, complexity, and adjuster expertise, making assignment more consistent across intake workflows. At the same time, integrations with claims, policy, CRM, and document management systems kept existing operational data connected to the new intake and preparation process.