ClaimEval: Scale Quality Assurance Beyond Sampling
Move from manual, sample-based QA to consistent inspections across your entire claims portfolio. Surface exceptions. Prioritize human effort.
The Sampling Problem
Traditional QA relies on random sampling, checking a small percentage of claims. Patterns slip through. Leakage compounds. Training gaps persist.
What if you could QA every claim?
100% Coverage, Intelligent Prioritization
ClaimEval runs defined inspection checks across all closed claims. It scores risk, flags issues and surfaces the claims that need human attention.
ClaimEval is a quality assurance layer. It augments your claims handlers, it does not replace them.
Key Features
Risk Scoring
Every claim scored based on configurable rules. Flag counts highlight potential issues. Sort by risk to prioritize review.
Inspection Catalogues
Pre-built checks designed for a range of insurance use cases. Configurable inspection definitions. Each check provides clear findings, context and next steps.
Reviewer Workflow
Filter by line of business, status, risk score etc. Track reviewed vs. not reviewed. Assess document reviewer findings.
Coverage Areas
Pre-built check catalogues for Motor, Home, Life, Warranty and more
Motor
- Claim Setup & File Integrity
- Liability & Decision Coherence
- Customer Communication
- Repair & Supplier Handling
- Total Loss & Valuation
- Credit Hire / AMC
- Financial Hygiene & Recoveries
Home
- Coverage & Causation
- Investigation & Evidence Adequacy
- Repairs & Supplier Oversight
- Cash Settlements & Vulnerability
- Alternative Accommodation
Life
- Policy Validity & Beneficiary Checks
- Cause of Death & Exclusion Review
- Medical Evidence Adequacy
- Payout Calculation
- Contestability Period Compliance
Warranty
- Coverage Scope & Component Eligibility
- Repair vs Replacement Logic
- Supplier & Parts Verification
- Cost Position & Excess
- Policy Term & Mileage Compliance
Run ClaimEval on Your Closed Claims
We'll analyze a batch of your historical claims and show you the inspection results, risk distribution and priority findings.
Book a Demo