RPA in Insurance Claims Processing

Solution We Delivered

Accelerating Insurance Claims Processing with RPA and AI for Greater Accuracy and Compliance

Claims processing is at the heart of any insurance organization’s success—but it often comes with challenges like manual data entry, fragmented information sources (fax, emails, scanned documents), regulatory compliance, and navigating legacy systems with data spread across multiple screens.

To address these inefficiencies, Robotic Process Automation (RPA) combined with AI was implemented to streamline claims handling, beginning at the First Notification of Loss (FNOL). The automation solution captured and entered claims data directly into the core system, eliminating manual tasks in the back office.

From FNOL to final payment—whether to customers or brokers—the claims process was fully automated. This transformation significantly improved processing speed, enhanced data accuracy, and ensured regulatory compliance, giving the organization a clear competitive advantage in delivering timely and efficient claims service.

Technology Used

Pega Robot Studio, Pega Robot Runtime Pega Robot Manager

C# Core Insurance Policy Admin Application

Connectors for Adobe Pdf, MS Excel, MS Word, MS Outlook
Robotic process automation bot managing insurance claim forms
Visual of digital claim processing using RPA dashboard
What we did

Automated Claims Data Entry

Eliminated manual data input by automating claims entry into core systems at the point of FNOL, enhancing speed and accuracy.

Seamless Handling of Multi-Source Information

Processed data from diverse sources—fax, scanned documents, emails, and PDFs—using AI-enhanced automation tools.

Optimized Legacy System Navigation

RPA bots efficiently managed data across multiple screens and legacy systems, reducing processing delays.

Faster Settlements, Improved Compliance

Accelerated claims resolution timelines while ensuring regulatory compliance and reducing human error—giving the organization a clear competitive edge.

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