AI triage routes high-risk claims to the right adjuster instantly
Problem Statement
High-cost claims are identified too late, leading to leakage, rework, and inefficient adjuster allocation. FNOL, claims, and imaging data live in silos, and unstructured notes are impossible to analyze at scale.
What's holding you back
Claims-only models missing external data
Poor NLP on adjuster notes
No clinician workflow integration
Ignoring model explainability
Junior adjusters miss litigation risk
What success looks like
Cycle time decreases 20% to 30%
Leakage decreases 5% to 8%
Reopen rate decreases
Claims per adjuster increases
Catastrophic claims routed immediately
How evolv helps
Integrates FNOL, claims, imaging, and external data with unified claim-level view
Applies NLP to adjuster notes surfacing severity signals at first notice
Embeds explainable scoring in clinician workflows with clear escalation protocols