Automatically score, segment, and prioritise incoming claims by complexity, value, and fraud indicators — so your best handlers focus on the cases that matter most.
When every claim lands in the same queue, experienced adjusters spend time on straightforward notifications while complex, high-reserve cases wait. Manual triage is inconsistent, unauditable, and struggles to keep pace with notification volumes — especially during surge events like storms or flood.
Without automated scoring, all claims are treated equally. High-value or complex cases sit behind simple windscreen or accidental damage notifications.
Different handlers apply different mental models to triage, producing inconsistent outcomes and making it impossible to benchmark handler performance.
Early fraud signals — policy inception proximity, repeat claimants, suspicious loss patterns — are buried in free text and not surfaced until investigation stage.
Weather events and catastrophe scenarios overwhelm manual triage processes, causing SLA breaches and regulatory complaints.
Purpose-built capabilities — not generic templates you have to work around.
Define weighted scoring rules across reserve band, peril type, claimant history, policy age, and geographic risk factors — all without code changes.
Automatically flag claims that match configurable fraud patterns — policy inception proximity, multiple claims in period, known fraud postcodes, and more.
Route claims into fast-track, standard, and complex handling streams based on triage score. Each track has its own SLA, authority levels, and escalation rules.
Monitor triage accuracy, average time-to-allocation, and track distribution in real time. Identify bottlenecks before they cause SLA breaches.
Pre-configured surge profiles automatically adjust triage thresholds and routing rules during catastrophe events, keeping claim flow moving.
A new FNOL record enters the triage engine. The system extracts structured data fields including peril, location, estimated value, and claimant details.
The rules engine applies weighted criteria to produce a triage score. Claims are segmented into fast-track, standard, or complex handling streams.
Configurable fraud indicators are checked against the claim data. Flagged claims are diverted to the fraud referral queue with a summary of matched triggers.
The scored claim is allocated to the appropriate handler based on stream, handler specialism, current workload, and authority level. SLA timers are set per track.
Every scoring decision, rule matched, and routing outcome is logged to an immutable audit trail for FCA evidencing and internal quality assurance.
Try these tools to assess and improve your operations.
Yes. SwiftCase provides a no-code rules editor where claims managers can add, remove, or re-weight scoring criteria. Changes take effect immediately and are version-controlled for audit purposes.
Surge profiles are pre-configured rule sets that adjust triage thresholds, fast-track criteria, and routing priorities. A claims manager can activate a surge profile in one click, and the system reverts to normal rules when the event subsides.
Out of the box, the engine checks policy inception proximity, multiple claims within a rolling period, known fraud postcodes, claimant repeat patterns, and time-of-loss anomalies. You can add custom indicators based on your own fraud intelligence.
See how SwiftCase scores, segments, and routes incoming claims — putting your best adjusters on the cases where they add most value.
