What a Claims department becomes
The same tasks, redistributed. Agents pick up the repeatable work, the roles that remain rebundle around judgment and oversight, and a few new roles appear to keep the agents honest. Nothing here is a headcount cut. It is a picture of where the work goes.
Workflow Reimagined
Each workflow splits into agent-led stages and human-led stages, with the handoffs your team keeps between them.
Claims Investigation and Adjustment
Workforce Reimagined
One card per role. Open a card to see which tasks move to agents, what new work the redesign creates, and how the role rebundles.
Auto Adjuster8 to agents
- Apply knowledge of auto physical damage to adjust claims.
- Identify, measure, monitor, and control risks associated with business activities in accordance with risk and compliance policies and procedures.
- Identify coverage concerns and review prior loss history.
- Gather information from police reports, recorded statements, and witness statements to determine liability.
- Document damage evaluation, investigation findings, negotiation actions, and settlement decisions.
- Apply knowledge of P&C insurance products, policy contracts, coverages, and internal claims handling procedures.
- Determine when to create Special Investigation Unit (SIU) referrals.
- Communicate with members, business partners, and claimants through multiple channels, including digital tools, to drive timely resolutions.
The role shifts from technical adjustment and evidence gathering to high-touch exception handling and catastrophe response, as the core investigation and valuation engine is now agent-native.
Motor Claims Advisor8 to agents
- Advise customers on insurance claim options in line with Motor Claims Framework (MCF) and GIA guidelines.
- Prepare accurate accident repair estimates and supplementary estimates when required.
- Verify customer details, update records, and maintain detailed case history including photos and reports.
- Finalize and close insurance invoices promptly.
- Follow up on unclosed cases for settlement.
- Liaise with internal departments to minimize vehicle downtime and ensure smooth workflow.
- Issue job sheets and repair orders.
- Handle internal jobs and fleet repairs.
The role is stripped of administrative and estimate-related tasks, focusing exclusively on physical vehicle handover and vendor negotiations that require human presence.
Claims Processor8 to agents
- Monitor daily reports outlining workflow and processing needs.
- Obtain, prepare, and approve invoices for claim filing.
- Assess invoices to minimize losses and financial exposure to the bank.
- Research loan history for advances and deposits.
- Review and consult with the Mortgage Insurance department regarding refunds.
- Determine whether refunds are needed.
- Upload required documentation into investor systems concerning advances or credits to accounts.
- Monitor loans for incoming claim funds.
Processing tasks are fully absorbed by the Payment Execution & Audit Closure agent, leaving only the non-candidate communication tasks with external legal and utility entities.
Complex Claims - TPA Oversight6 to agents
- Identify and evaluate coverage issues.
- Prepare comprehensive coverage letters with supervisory review and analysis.
- Coordinate vendor referrals for additional investigation.
- Coordinate vendor referrals for litigation management.
- Monitor reserve accuracy throughout the life of the claim.
- Control independent adjuster costs.
The role evolves into a legal and strategic oversight function, focusing on counsel direction and high-level business partner communication while the agent handles coverage evaluation and reserve monitoring.
Catastrophe Claims Advisor9 to agents
- Set up appraisals for claims.
- Assign contractors to claims.
- Generate financial transactions related to claims.
- Finalize settlements in a timely manner.
- Review inspection reports and estimates to confirm damages are related to the loss.
- Determine when additional inspection is needed.
- Follow up with customers on claim status.
- Adjust claims quickly and accurately in accordance with policy coverage.
- Leverage external vendors when appropriate.
The role transitions from operational adjustment to high-level customer reconciliation and complex cause-of-loss support, as the agent manages the transaction and appraisal pipeline.
Property Adjuster Specialist - Field4 to agents
- Identify, measure, monitor, and control risks associated with business activities in accordance with risk and compliance policies and procedures.
- Maintain accurate, thorough, and current claim file documentation throughout the claims process.
- Identify and resolve discrepancies in claim information.
- Use estimating technology platforms and virtual inspection tools to prepare claims estimates.
The role focuses on physical inspections and high-complexity legal/jurisdictional challenges, while the agent handles the documentation and risk monitoring layers.
Settlement Authority Lead
- Collaborate with management to determine settlement amounts outside authority limits.
- Develop settlement recommendations for claims outside authority limits.
- Handle higher-complexity claims and additional work outside normal duties as needed.
- Adjust complex claims involving attorney participation.
Balance Sheet Reimagined
The redesign as a ledger: what moved, what is new, and how each role's task load nets out.
| Role | To agents | New work | Net change |
|---|---|---|---|
| Auto Adjuster | 8 | 0 | -8 |
| Motor Claims Advisor | 8 | 0 | -8 |
| Claims Processor | 8 | 0 | -8 |
| Complex Claims - TPA Oversight | 6 | 0 | -6 |
| Catastrophe Claims Advisor | 9 | 0 | -9 |
| Property Adjuster Specialist - Field | 4 | 0 | -4 |
- Roles and tasks come from our task corpus, not from any one company. The classifier is the same one behind Explore.
- The redesign was generated and validated offline, then committed as a fixed example. It is industry-generic and carries no company-specific or tenant data.
- Headcount is left out on purpose. This shows where work goes, not how many people do it.
- In a tenant, the same engine runs on your own department, and every move is a proposal your team accepts or edits before anything changes.