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Claims Triage

The automated sorting of incoming claims by complexity, severity, or risk — routing simple claims to fast-track or straight-through processing and complex on.

industryPublished 2026/06/05

FAQs

What does claims triage do?
It sorts incoming claims by complexity and severity, routing simple ones to fast-track processing and complex ones to experienced adjusters.
How does AI improve triage?
It weighs more signals — severity predictors, fraud and litigation indicators — than a human can quickly assess, often flagging escalation risk right at FNOL.

Related Terms

  • First Notice of Loss (FNOL)

    FNOL is the initial report a policyholder makes to an insurer when a loss or accident occurs

  • Straight-Through Processing (STP)

    STP is the automated handling of a transaction

  • Cycle Time

    The total elapsed time to complete a process — most often a claim from first notice to closure.

Related Items

  • Five Sigma

    AI claims management with adjuster decision support

  • EvolutionIQ

    AI claims guidance for disability and injury lines

  • Charlee.ai

    Predictive analytics for claims litigation

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Claims triage is the sorting step that decides how each incoming claim should be handled. Not all claims are equal: a straightforward windshield replacement needs different handling than a complex injury claim with litigation potential. Triage assesses each claim early and routes it appropriately — simple claims to fast-track or automated processing, complex or high-severity ones to experienced adjusters.

Good triage is leverage. By directing the right claim to the right resource immediately, carriers process simple claims faster and cheaper (often straight-through) while ensuring complex claims get the expert attention that controls cost and outcome. Poor triage wastes senior adjusters on trivial claims and lets complex ones slip through under-resourced.

AI sharpens triage by assessing claims on more signals than a human could weigh quickly — claim characteristics, severity predictors, fraud indicators, litigation likelihood. It can flag, at FNOL, that a seemingly routine claim has markers of escalation, getting it the right attention before it spirals.

For carriers and TPAs, triage quality affects both cost (cycle time, leakage, litigation) and customer experience (fast resolution of simple claims). Tools in this space often combine with FNOL and fraud detection. The useful evaluation questions: what signals drive the triage, how accurate is severity/complexity prediction, and how cleanly does it route into the claims workflow.