Does claims automation replace our claims system?

It doesn't have to. Many insurers and administrators keep their core policy and claims systems as the record and add an orchestration layer above them for the work: the cases, documents, tasks, partners, and deadlines. That layer exchanges data with the core system through its API, file imports, and webhooks.

Which parts of a claim should be automated first?

Start where volume is high and results are easy to check: filing incoming documents, extracting data from first-notice packets and estimates, routing claims to the right workflow, and generating routine correspondence. Keep coverage and settlement decisions with people, supported by the data.

Can independent adjusters and vendors work in the same system?

Yes, if the system enforces row-level security. A partner assigned to a claim should see that claim and the records beneath it, and nothing else on the policy or in your book, with access that updates as assignments change.

How is AI used in claims processing?

To classify incoming documents, extract data with confidence scores, transcribe recorded calls, and draft review memos and replies for people to check. The workflow decides when a model runs and where its result goes; uncertain results go to a person.

What about subrogation?

Recovery works best as its own case linked to the claim, with its own counsel, documents, deadlines, and ledger of costs and recoveries, so it doesn't get lost once the claim is paid.

Guides

What is insurance claims automation?

Reviewed October 23, 2026

The short answer

Insurance claims automation uses software to run the repeatable work of each claim, such as intake, document filing and data extraction, routing to the right workflow and adjuster, deadlines, correspondence, and recovery, so claims staff spend their time on judgment instead of paperwork.

A claim is a burst of work with a deadline attached: a first notice to log, documents to file and read, coverage to check, an adjuster or vendor to assign, correspondence to send, payments to track, and sometimes a recovery to pursue. Most of that work is repeatable. The judgment calls in the middle are what claims professionals are for.

Insurance claims automation takes on the repeatable work, so each claim moves on time, with its evidence in one place, and people spend their time on decisions.

What can be automated in a claim

Stage	What automation does
Intake	Opens each new claim as a case on the policy from a file, form, or email, and starts the workflow that claim type needs.
Documents	Splits first-notice packets into their forms, reports, and estimates; classifies each one; extracts totals, dates, and line items with confidence scores.
Routing	Chooses the workflow, team, and priority from the claim’s data, such as state, coverage, or amount.
Partners	Assigns independent adjusters, repair vendors, and counsel, who work their assignments in the same system.
Deadlines	Measures due dates in business time and escalates work that’s at risk.
Correspondence	Generates letters and review documents from claim data, and links inbound email to the claim.
Recovery	Opens subrogation as its own case, generates the demand package, and tracks costs and recoveries.
Audit	Records every step, by every person, partner, and model, against the claim.

Where people stay in the loop

Automation works best when it’s honest about what it doesn’t know. Extracted values should come back with a confidence score; anything below your bar goes to a person on a work queue, with the source document beside the value. Coverage decisions, settlements, and exceptions stay with claims staff, who now start from organized evidence instead of a pile of attachments.

Claims automation vs. a new claims system

Replacing a core claims or policy administration system is a multi-year project. Claims automation often doesn’t require it: an orchestration layer can sit above the system of record and run the work around each claim, exchanging data with the core system through its API, file imports, and webhooks. The same layer can run policy work, such as onboarding, renewals, and annual reviews, as cases on the policy.

What to look for

Each claim as a case, with its own workflow, documents, deadlines, parties, and ledger.
Rules that choose the workflow from the claim’s data, maintained by the business.
Document AI with confidence scores and a review queue for uncertain results.
Partner access with row-level security, so adjusters and vendors see only their own assignments.
Business-time deadlines and escalation, on your calendar.
Recovery as its own case, linked to the claim.
Choice of AI model, by configuration, and AI that runs inside your security and audit trail.
Works with your core system rather than replacing it.

How Quandis approaches claims automation

QBO opens each new claim as a case on the policy and starts the workflow that claim type needs, chosen by a weighted rules matrix from data such as state or coverage amount. Inbound email links itself to the claim, attachments included. QDocs splits first-notice packets and extracts estimate and invoice data with a confidence for every value. Independent adjusters, repair vendors, and counsel work their assignments directly in QBO and see only their own claims. Recovery runs as its own case, with its demand package generated from claim data and its costs and recoveries posted to a ledger. QBO sits above your policy administration and claims systems and exchanges data with them; it is in production in insurance today.