Clifford Bernard

CaseC-0001

Parking-lot fender-bender

A small, clean, well-documented claim: the case automation is for.

auto claim · $1,850

What the claimant wrote

Simple Auto Claim, minor fender-bender in parking lot. Another driver backed into my 2019 Honda Civic at low speed; bumper cover and tail light damaged, vehicle drivable, other party accepted fault. Repair estimate $1,850.

At a glanceEvery version

This claim through all ten versions

0Today

By hand

The claim joins one queue with every other claim and waits about 5.0 days for an adjuster to read it, check the policy and decide.

W0 to W3: turning the answers into a decision

  1. W0 · Trust the one big answer

    Sent to a person: nothing allowed it to go ahead alone. The right call

    The steps it went through
    1. Code R-HV-50K not fired: Claims over $50,000 require mandatory human review
    2. Code R-INJECTION not fired: Suspected manipulation of automated processing quarantines the claim
    3. Code R-FRAUD not fired: Claims with fraud indicators require investigation
    4. Code R-POLICY not fired: Claims on a policy that is not in force go to a human (denials are never automatic)
    5. Code R-TYPE-CONFIDENCE not fired: Uncertain claim type cannot be routed automatically
    6. Code R-SPECIALIST not fired: Claims needing domain expertise are assigned to a specialist
    7. Code R-DENY-NEEDS-HUMAN not fired: A recommended denial is always reviewed by a person
    8. Code R-INCOMPLETE-CONFLICT not fired: Approval recommended on a submission judged incomplete
    9. Code R-AUTO-APPROVE not fired: Auto-approval: approve recommended with sufficient confidence, low fraud risk, adequate documentation, value within limit
    10. Code R-AUTO-RMI not fired: Automatic request for missing information
    11. Code R-DEFAULT-HUMAN FIRED: No automatic rule applied: route to human review Decided here
    12. Person Disposition human_review by R-DEFAULT-HUMAN

  2. W1 · Combine the small answers

    Paid automatically. The right call

    The steps it went through
    1. Code Claim C-0001: $1,850, policy active.
    2. Decision model The model answers fourteen typed questions about completeness, evidence and fraud; code decides, it never does.
    3. Code Claims over $50,000 require mandatory human review
    4. Code Suspected manipulation of automated processing quarantines the claim
    5. Code Claims with fraud indicators require investigation
    6. Code Claims on a policy that is not in force go to a human (denials are never automatic)
    7. Code Claims needing domain expertise are assigned to a specialist
    8. Code Code combines the narrow answers and acts on the least certain one: 71.3% confidence.
    9. Code Certain enough, so it is handled with no person. Decided here
    10. Code Handled with no person: paid.

  3. W2 · Learn how much to trust each answer

    Paid automatically. The right call

    The steps it went through
    1. Code Claim C-0001: $1,850, policy active.
    2. Decision model The model answers fourteen typed questions about completeness, evidence and fraud; code decides, it never does.
    3. Code Claims over $50,000 require mandatory human review
    4. Code Suspected manipulation of automated processing quarantines the claim
    5. Code Claims with fraud indicators require investigation
    6. Code Claims on a policy that is not in force go to a human (denials are never automatic)
    7. Code Fourteen learned weights score approval at 99.7% and a request for information at 2.3%; the higher one is proposed.
    8. Code Certain enough, so it is handled with no person. Decided here
    9. Code Handled with no person: paid.

  4. W3 · Be stricter as amounts rise

    Paid automatically. The right call

    The steps it went through
    1. Code Claim C-0001: $1,850, policy active.
    2. Decision model The model answers fourteen typed questions about completeness, evidence and fraud; code decides, it never does.
    3. Code Claims over $50,000 require mandatory human review
    4. Code Suspected manipulation of automated processing quarantines the claim
    5. Code Claims with fraud indicators require investigation
    6. Code Claims on a policy that is not in force go to a human (denials are never automatic)
    7. Code Fourteen learned weights score approval at 99.7% and a request for information at 2.3%; the higher one is proposed.
    8. Code The certainty needed grows with the amount at stake: doubt is scaled by the claim's value against a $5,000 reference, giving 99.7% confidence.
    9. Code Certain enough, so it is handled with no person. Decided here
    10. Code Handled with no person: paid.

Around W3: the work people still do, and what else was tried

  1. + A quick confirmation for near-certain claims (now for requests only)

    Paid automatically. The right call

    The steps it went through
    1. Code The fitted workflow handles this claim with no person; no lane is needed.
    2. Code Handled automatically; this claim never reaches a lane.

  2. + Grade the fraud response

    Paid automatically. The right call

    The steps it went through
    1. Code The fitted workflow handles this claim with no person; no lane is needed.
    2. Code Handled automatically; this claim never reaches a lane.

  3. + A second vote on near-misses (a negative result)

    Paid automatically. The right call

    The steps it went through
    1. Code The fitted workflow handles this claim with no person; no lane is needed.
    2. Code Handled automatically; this claim never reaches a lane.

  4. + Ask the customer one question

    Paid automatically. The right call

    The steps it went through
    1. Code The fitted workflow handles this claim with no person; no lane is needed.
    2. Code Handled automatically; this claim never reaches a lane.

  5. + Watch after the decision

    Paid automatically. The right call

    The steps it went through
    1. Code The fitted workflow handles this claim with no person; no lane is needed.
    2. Code Handled automatically; this claim never reaches a lane.