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IntelliClaim, powered by Pega platform, revolutionizes the claims processing workflow for Life claims.

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The current claims processing workflow for Life claims faces significant challenges. Manual registration, inadequate fraud detection, document validation issues, and difficulty retrieving policy information contribute to operational inefficiencies, longer processing times, manual errors, and heightened fraud risks. Consequently, these issues culminate in decreased customer satisfaction and prolonged processing durations. IntelliClaim with advanced workflow automation and Generative AI (GenAI) enhances every step of the claims process—from initial registration to final resolution. Leveraging Natural Language Processing for swift claims registration and advanced data analysis for early fraud detection, this intelligent solution ensures document accuracy, streamlines validations, and provides, and provides concise policy summaries to aid adjusters. The result is a significant boost in efficiency, accuracy, and customer satisfaction, while also reducing backlogs and operational risks.

Key Features

  • IntelliClaim orchestrates the Life Claim process from First Notice of Loss (FNOL) to claim resolution, including the management of separate payment cases for each beneficiary, AI based assignment to Claim Assessor, One Claim process for policy holders holding multiple products across business lines
  • Leveraging both Generative AI and Natural Language Processing, IntelliClaim provides sophisticated fraud detection and document validation, setting it apart from traditional claims processing solutions.
  • System validations such as duplicate claims checks, verification of Data against DMF (Death Master File), OFAC checks with State-level rules, document validation and cross-reference data with policy information to ensure quicker resolutions and smoother claim processing
  • Early identification of fraudulent claims through advanced data analysis techniques helps reduce financial losses and maintain the integrity of the claims process.
  • Automated claim registration based on DMF file ingestion, email correspondence with auto-filled Claim Form, providing ability for Customers to upload documents seamlessly for Claim Processing.
  • With robust APIs and seamless integration capabilities, IntelliClaim can easily integrate into existing systems, providing flexibility and scalability for insurers.


=Maantic Inc.

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