Solutions, By function, Claims operations

The complete file, on day one

A claim file gets read eleven times by five people before a decision. Owl reads it once, builds the structured file the rest of the team works from, surfaces the questions a senior examiner would ask, and drafts the next-action memo, from FNOL through close, across every line you write.

Where a claim file spends its lifeIndustry baseline, n=2.4M files
FNOL, intake
100%, all files
0–2 days
Triage, routing
86% routed correctly first try
+1 day
Investigation
72% reach examiner with full file
+5–14 days
Decision
41% decided within plan SLA
+22 days
Close, pay
28% close clean (no re-open)
+34 days

11×

Times the file is re-read

38%

Cycle time spent waiting to read

$214

Cost per file read

02The toolkit

Three AI agents on every file. From FNOL to close.

OwlVision

It reads what no one has the hours to read.

3.2B
Claim documents read
OwlSignal

It watches what the file alone cannot show.

9.2M
Eligibility insights delivered
OwlAssist

It has read every page. Ask it anything.

47.6M
Examiner questions answered
OwlEnrich

It pulls the context that's not in your file.

12.4M
Claimant records enriched
03Examples by line of business

Pick a line. See how Owl reads the FNOL, decides the next action, and drafts the file.

Same three agents, same workflow, every line of business. The data and the protocol change; the discipline doesn’t.

OwlVision
What it read
FNOL + recorded statement
14 pp
● Read, Indexed
Police report + diagram
8 pp
● Read, Liability scored
Medical record (ED + PT)
162 pp
● Read, ICD-mapped
Policy + endorsements
48 pp
● Read, Coverage-walked
Structured extraction
Claim AB-2025-44218, rear-end collision 2025-06-04, insured at fault (admitted), claimant 41M, soft-tissue and lumbar strain, UM/UIM not triggered, BI limit $100K, gap: no wage-loss statement on file
OwlSignal
What it cross-referenced
● high
Treatment pattern, prior-carrier history

Claimant has 3 prior soft-tissue BI claims (ISO ClaimSearch); same chiropractic clinic and same MRI center on 2 of 3. Pattern flag for SIU referral within 14 days.

● mid
Wage statement, employer feed

Equifax Work Number: claimant W-2 employed 2024-2025; wage-loss claim of $4,200 inconsistent with 1099 self-employment claim made at FNOL.

● low
Treater licensure, state board

Treating chiropractor: license active; 1 prior board action 2019 (settled). No current sanction.

OwlAssist
What it answered
Examiner asked
What’s the next action and the reserve recommendation?
Owl answered in 0.8s

Issue the wage-loss request letter today, refer the file to SIU on prior-treatment pattern, and set the reserve at $24K (P50) / $52K (P90) given the soft-tissue presentation, the prior-claim pattern, and the BI policy limit. Diary 30 days out for SIU report and 14 days for wage-statement receipt. Draft letters and diary memo attached.

ISO ClaimSearch: 3 priorsWork Number 2024-2025Policy §4 BIP50/P90 reserve cohort

How Owl plugs into the claims-ops day. No replacement, no rip-and-replace.

01OWL

FNOL hits the queue

Loss notice, photos, recorded statement, policy bind. Owl reads it all in seconds and writes the structured intake.

02OWL

Triage routes the file

Routing-confidence score, severity prediction, SIU/subro/legal referral flags. Examiner sees the file already pre-screened.

03EXAMINER

Examiner takes ownership

Loads the file with structured extraction, signals and a draft next-action memo. Validates and edits.

04OWL

Owl drafts the next move

Coverage letter, reservation-of-rights, claimant outreach, diary entry. Every span cited. Examiner approves with one click.

05EXAMINER

Decision, close

Examiner makes the call. Owl writes the close-out memo with the audit trail attached for QA + state DOI.

05What changes

Numbers from carriers running Owl in claims operations.

MetricWithout OwlWith Owl
FNOL → triage decision36 hr2.4 hr
Files reviewed per examiner / day4.211.8
Cycle time, simple liability claims34 days11 days
Re-open rate within 90 days14%4.2%
Loss-adjustment expense per file$1,840$610
Examiner satisfaction (NPS)+12+58
Source: rolling 12-month average across 7 carriers, n = 1.4M files, L&H, P&C and Health books combined.

Built for the regulatory shape of multi-state, multi-line claims operations.

Unfair Claims PracticesNAIC Model #672 timing and content of communications, by state.
ERISA, §503Reasoned, documented LTD/STD decisions with full administrative record.
HIPAA, HITECHPHI segmented per tenant. Detailed access log per record.
State DOI examinationsAudit trail per claim, per touch, per citation.
Reg AI / NYDFSBias testing, model lineage, decision-explainability per file.
SOX 404Internal control documentation for reserve and payment systems.
SOC 2 Type IIAnnual audit, continuous control monitoring.
Records retentionPer state, per carrier, per LOB.
07Integrations

Lives where your claims operations team lives.

Claims platforms

Guidewire ClaimCenter, Duck Creek, FINEOS, Origami, Majesco, in-house

Document intake

Box, OnBase, ImageRight, Documentum, ECM

Industry data

ISO ClaimSearch, LexisNexis, CCC, Mitchell, CoreLogic

Medical & wage

MRO, Verisma, Datavant, Equifax Work Number

Communications

Email, SMS, letter, DocuSign, twilio, genesys

Identity & SSO

Okta, Azure AD, PingFederate, SAML, SCIM

08Get started

Bring us a week of new FNOLs. We’ll send back the file your examiner would have built.

Two-week pilot. Your stream, your tenant, your policies. We measure intake-to-triage time, routing accuracy, draft-acceptance rate and re-open rate against your team’s ground truth.

Book a claims operations briefing