Insurance

Bring the whole claim into view.

Assemble policy terms, claim evidence and review decisions from first notification through settlement.

Connected work in insurance

Prepare the claim before the decision.

A claim can depend on policy wording, documents, previous events and specialist input. Bring those facts together and keep unresolved questions with the claims owner.

Bring your existing systems

Policy administration
Claims system
Document intake

Connect the accounts and actions your process needs, with the appropriate access and review.

Processes in insurance

Where could you put
Mossaic to work?

Explore 6 examples, from the event that starts the work to the decision and the recorded result.

Claims Validation (P&C)

A property or casualty claim enters review.

AI prepares
Extract claim facts and gather the relevant policy wording.
Rules check
Check document completeness, policy dates and coverage conditions.
People decide
A claims reviewer determines coverage and handles exceptions.
Systems record the result
A reviewed claim packet with the decision and outstanding conditions.

First Notice of Loss (FNOL)

A policyholder reports a loss.

AI prepares
Read the notification and gather policy and event details.
Rules check
Check intake requirements and route by the configured severity criteria.
People decide
The claims handler confirms the next action and specialist involvement.
Systems record the result
A classified claim with an owner and the next review tasks.

Fraud Investigation

A claim is referred for possible fraud.

AI prepares
Correlate claim history, policy details and supporting evidence.
Rules check
Check the configured investigation indicators and escalation criteria.
People decide
An investigator decides the inquiry and its outcome.
Systems record the result
An investigation record with supporting evidence and assigned actions.

Commercial Underwriting

A commercial risk submission arrives.

AI prepares
Prepare exposure, loss-history and supporting-document summaries.
Rules check
Compare the submission with the configured underwriting criteria.
People decide
An underwriter evaluates the risk and approves terms or referrals.
Systems record the result
An underwriting decision with terms, conditions and review evidence.

Appeals Review

A policyholder appeals a claims decision.

AI prepares
Gather the original decision, policy wording and new evidence.
Rules check
Check appeal requirements and identify the disputed findings.
People decide
The authorised appeal reviewer decides whether the decision changes.
Systems record the result
A documented appeal outcome and approved communication.

Reinsurance Settlements

A reinsurance settlement is due.

AI prepares
Compare claim, treaty and payment records.
Rules check
Flag differences against the configured contract and settlement rules.
People decide
The settlement owner resolves discrepancies and approves the statement.
Systems record the result
A reconciled settlement record with sign-off and follow-up actions.

Coverage, underwriting and investigation decisions remain with the authorised specialists. The examples are configured around your policies and claims systems.

Have another process in mind?

Discuss your process Explore other industries

Start with the work on your mind

Where does your
process get stuck?

Bring a process, a recurring exception or a handoff that takes too much chasing. We’ll explore where Mossaic could help.

Book a demo