Insurance Claims Automation
A claim doesn't need eight people and three weeks. It needs eight seconds and a rule.
Unmeshed runs FNOL, coverage checks, fraud screening, and adjudication as one governed workflow. AI reads the documents. Rules make the calls that should always be consistent.
Adjusters stay in the loop for anything that actually needs judgment.
Trusted by teams at leading organisations
The Real Question
Does this step need judgment, or just a rule executed consistently?
Most claims steps, once you ask that honestly, land on the rule side. That distinction is what separates automation a regulator can approve from automation nobody can fully explain.
Claims Intake
Event Intake and Signal Validation
Claims processing starts with high volume intake. Entry point validation keeps incomplete claims from consuming expensive downstream checks.
- RULE
Validate required fields and policy context at entry
- RULE
Stop malformed or duplicate claims before they reach adjusters
- RULE
Create a stable case ID so every claim stays traceable
Claims Intake Path
Ingest Claim
# claim.ingest
Validate Fields
# Switch
Assign Case ID
# case.create
Exit
# stop
Risk Enrichment
Parallel Signal Enrichment
Once a claim is accepted, enrichment runs concurrently. Fetching policy history, fraud signals, and third-party risk data in parallel keeps decisions fast.
- RULE
Fetch policy, fraud, and history signals in parallel
- RULE
Normalize responses into one risk object
- AI
Flag inconsistencies in claimant-submitted documents
Parallel Signal Enrichment
Fetch Signals
fan out
Policy History
# policy_lookup
Fraud Signal
# fraud_ai_check
Claim History
# history
Organize Risk Object
Underwriting Decision
Decision Engine for Claim Routing
Underwriting policy changes often. Keeping criteria in decision tables instead of backend code means updates don't require a redeploy.
- RULE
Keep approval and denial criteria in editable decision tables
- RULE
Route outcomes to auto-approve, manual review, or deny
- HUMAN
Send flagged cases to an adjuster with full context
Claim Routing Path
Decision Table
# decide_claim
Auto-Approve
clean claim
Adjuster Review
flagged
Deny
policy violation
Human Review
Human Review for High-Risk Claims
Some claims need adjuster judgment. Human in the loop steps let the workflow wait without custom scheduling code, preserving full context for review.
- HUMAN
Pause high-risk claims at adjuster checkpoints with full context
- RULE
Resume from the same state when a reviewer acts
- RULE
Preserve auditability across long-running investigations
Human-in-the-Loop Path
Ask Adjuster
# wait_for_review
Reviewer Acts
async
Resume
# finalize
Across a live underwriting deployment, only 9 of 45 capabilities actually needed a model. AI cost per submission dropped from $0.41 to $0.08, an 80% reduction, without losing accuracy on the steps AI was handling.
Same orchestration model, applied to claims: AI on the steps that need judgment, code on everything repeatable.
9/45
Capabilities that needed AI
80%
Lower AI cost per submission
36
Ran as deterministic code
Industry-wide, insurers running a governed automation model this way report claims cycle times falling 30 to 75% and straight-through processing on 70 to 90% of low-complexity claims. (Industry benchmarks — McKinsey 2025, Hiscox/Moody's case study, Ping An reporting. Not Unmeshed customer results.)
Connects to Your Stack
100+ built-in integrations. Plus hosted functions for anything custom.
Inside the Workflow
Four pieces, one workflow.
Decision tables
The rule that keeps showing up, encoded once.
Coverage checks, deductible math, and payout thresholds run as editable rules. Update policy without a code deploy.
Human in the loop
Adjusters review, not re-key.
Standard claims move straight through. Anything flagged routes to an adjuster with an AI-drafted summary, not a blank file.
Fail-safe execution
Recovery is a command, not an incident.
Native hold, skip, and retry on any step, mid-run, without restarting the case from scratch.
Full audit trail
What ran, what data it used, what it decided.
Every step logged automatically, including AI steps. The difference between explaining a decision to NAIC and guessing at one.
Answers to a Regulated Environment
The kind of scrutiny NAIC and NYDFS actually apply.
RBAC
Scoped access controls and reusable roles across your organization.
SSO / SAML
Identity and access management that plugs into what you already run.
Audit logging
Every action, every case, timestamped and searchable.
SOC 2 Type II
Compliant with SOC 2 Type II and GDPR requirements.
Frequently asked questions
Still have questions? Talk to us.
Cut your claims processing costs.
We'll map your current claims workflow, show you exactly where the cost is, and have Unmeshed running in weeks, not months.
Free tier, no credit card required