Software Project

ClaimWise Claims Processing Engine

For ClaimWise Insurance · 2024 · 7 months

-56% Manual review time
2.3 days Faster average claim resolution
99.4% Auto-approval accuracy

An automated claims triage engine that cut manual review time on straightforward claims by more than half.

01 Overview

ClaimWise processed every insurance claim through the same manual review queue regardless of complexity. We built a triage engine that automatically routes straightforward claims for fast-track approval and flags complex ones for full review.

02 The Challenge

Simple, low-risk claims sat in the same queue as complex disputed ones, meaning customers with straightforward claims waited days for what should have been a same-day approval.

03 The Solution

We built a rules-and-model-based triage engine that scores incoming claims for complexity and fraud risk, auto-approving low-risk claims within policy limits and routing everything else to the right reviewer tier.

Python FastAPI PostgreSQL scikit-learn
Claims triage dashboard, risk scoring detail, and reviewer queue — screenshots available on request under client NDA.
“

Straightforward claims now clear same-day instead of sitting in a queue behind complicated ones.

Client Name · VP of Claims, ClaimWise Insurance
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