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 2-5% 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, without replacing human judgment.
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 for Motor, Home, Life, Warranty, and more. Customizable inspection definitions. Each check answers: What? Found? Why it matters? Next action?
Reviewer Workflow
Filter by LOB, status, risk score. Track reviewed vs. not reviewed. Document reviewer findings.
See ClaimEval in Action
Interactive demo of claims inspection and review
Inspection Zones
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
Reserve Adequacy Check
Compares initial reserve against final settlement amount across all closed claims. Flags cases where the reserve was more than 30% below the final payout, indicating potential under-reserving patterns.
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.
Request a Pilot