Solution

Insurance claims automation platform: faster settlement and loss-ratio control

Insurance claim settlement at most regional insurers takes weeks and depends on adjuster manual work. This hurts customer experience, loss ratio, and regulatory standing. The platform automates intake, assessment, document workflow, payout, and post-settlement control — without replacing the insurer's core system.

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This page describes the Samarali Soft approach to the insurance claims automation platform — a unified managed settlement process with digital intake, anti-fraud contour, and automated decisioning for simple cases. Not insurer core replacement but a layer above it accelerating customer experience and reducing loss ratio.

Target Model

How It Should Work

A claim is filed by the customer through a mobile app or personal cabinet with photo and video evidence attached. The platform automatically classifies the case, creates a file, assigns an adjuster by routing rules. The adjuster works in a unified workspace: photos, documents, customer history, similar case history, recommended limits. Simple cases (small KASKO, household insurance) can pass through automated rule-based decisioning. Complex cases are escalated to a person with pre-assembled context. Payout flows through partner-bank integration. Every decision, payment, and communication is logged for the regulator and for subsequent loss-ratio analysis.

Digital claim intake through mobile app and personal cabinet

Document validation and classification with computer vision support

Unified insurance case file with customer and similar-case history

Adjuster workspace with decision templates and recommended limits

Automated rule-based decisioning engine for simple cases

Anti-fraud contour with pattern and anomaly detection

Payout integration with partner bank or payment service

Real-time portfolio loss-ratio analytics

Regulatory reporting on settlement timing and quality

Audit log for regulator and internal control

Проблемы

Где обычно все ломается

Insurer core system does not support modern workflow — the adjuster works around it

Customer documents arrive by email or are accepted in office — no digital intake with validation

No unified case file — photos in one folder, the report in another, correspondence in a third

Payout decisions are made without comparison to similar cases — different amounts for similar circumstances

Anti-fraud check is absent or selective — fraudulent schemes repeat

Regulatory reporting is assembled manually from several sources

Consequences

What This Leads To

⚠ Customer NPS is low — every settlement case becomes a negative experience

⚠ Customer churn after first settlement — instead of loyalty the company gets the opposite

⚠ Portfolio loss ratio grows faster than premiums — no early signals of problem products

⚠ Fraudulent payout share remains high — repeat schemes are not blocked

⚠ Regulator moves from consultations to sanctions on payout timing

⚠ Embedded partnerships with banks and marketplaces become impossible — bank partners do not sign integration with a slow process

My Approach

How I Approach the Challenge

I start by reviewing 50-70 actual cases from the last 6 months — KASKO, motor, property, corporate. I walk through each: when the claim arrived, when the adjuster was assigned, when the document package was assembled, when the decision was made, when paid. I measure actual hours and bottleneck reasons at each step. In parallel, interviews with adjusters: what work is annoying, which steps are duplicated, where automation would help. On this quantitative base, prioritization is built — what to automate first, what to defer.

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Team

How We Work

My Role

I help the insurance company move from 'we have a core system but real work happens in Excel' to 'a unified managed settlement process'. I review actual adjuster and contact center work, design the target model, align with operations, the risk team, and the legal department. A separate part of the work is negotiating with the partner bank on payout integration and with the regulator on the approach to automated rule-based decisioning. Without these negotiations the technology contour hits bureaucracy in the first phase.

Team Role

The team builds digital claim intake, unified case file, adjuster workspace, rules engine for automated decisioning, anti-fraud contour, partner-bank payout integration, real-time loss-ratio analytics, regulatory reporting, audit log. In parallel — adjuster and contact center training on the new operating model.

Important

Key Considerations for Implementation

🔎 Rule-based automated decisioning is a legally sensitive area, requires regulator approval and clear perimeter

🔎 Anti-fraud contour requires historical case base of 2-3 years for model training

🔎 Partner-bank payout integration is a separate workstream with AML alignments

🔎 Adjusters at project start may sabotage the new model — requires change management

🔎 Simple cases may make up 60-70% of flow — automation priority is exactly there

🔎 Complex corporate cases stay manual — that is normal, not the project goal

Results

What Results to Expect

✓ Average KASKO settlement time drops from 14+ to 3-5 days

✓ Standard motor insurance — from days to hours through automated rule-based decisioning

✓ Share of automated decisions on simple cases — 50-60% of flow

✓ Fraudulent payout share drops 30-50% through anti-fraud contour

✓ Real portfolio loss ratio is visible in real time, not at quarter close

✓ Embedded partnerships with banks and marketplaces become technically possible

✓ Regulator inspection readiness — log and metrics generated automatically

Практика

Cases for This Solution

insurance

Digital transformation of insurance claims settlement: from paper to a unified managed process

A regional insurer with a mid-size KASKO and property portfolio moved claim settlement from a paper process to a digital platform. From first city pilot to full migration — 14 months. Average KASKO settlement time dropped from 16 days to 4.

Average KASKO settlement time dropped from 16 to 4 days

Share of automated decisions on simple cases — 55% of flow

Fraudulent payout share dropped 40% through anti-fraud contour

FAQ

Frequently Asked Questions

Is automated payout decisioning legally possible?

Possible with a clearly defined perimeter: loss type, fixed limit, low fraud risk, customer consent for automated processing. The regulator usually does not prohibit directly but requires transparency of rules and ability to appeal. Best implementations went through pre-approvals with the Ministry of Finance or ARRFR with pilot mode.

How long until visible effect?

Digital claim intake and unified case file — first visible effect in 4-6 months. Automated decisioning for simple cases — 9-12 months. Anti-fraud contour with trained models — 12-18 months. Full operating model maturity — 24 months. Anyone promising 'automated insurance in 6 months' is either simplifying scope or building a separate product island.

Should the insurer core system be replaced?

In most cases — no. A modern claims automation platform is built on top of the existing core. Core replacement is a separate strategic task spanning 24-36 months. The platform delivers measurable effect faster and without operational stoppage risk.

Is embedded insurance with a bank partner part of the project?

Not necessarily from day one, but the platform must be architecturally ready for it. If a bank or marketplace partnership for embedded products is planned, the API layer is laid in from day one. Otherwise the platform will require rework a year after launch.

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