Yesp StudioConfidential · Enterprise Insurer
92% straight-through processing and faster cycle times across high-volume lines.
High-volume manual claims handling capped throughput and customer experience.
Context, scope, and success criteria
Claims specialists were spending too much time on repetitive extraction and triage work, which limited throughput and extended customer cycle times. The insurer wanted automation, but only if the control model remained auditable and safe for exceptions.
- Increase straight-through processing safely without sacrificing review quality on edge cases.
- Maintain transparent and auditable decisions for all automated recommendations.
- Improve claims cycle times in high-volume lines and reduce manual backlog pressure.
- Let human reviewers focus on the exceptions that actually required judgment.
Why the work started
High-volume manual claims handling capped throughput and customer experience.
What we built
An agentic AI claims platform with human-in-the-loop review for edge cases.
Legacy versus modern flow
Manual claims triage, document-heavy workflows, and decision tracking spread across too many tools to scale efficiently.
An auditable AI claims workflow with extraction, policy reasoning, and human-in-the-loop review for exception handling.
How the work was executed
Mapped the top claim journeys and the decision bottlenecks that caused the longest delays.
Implemented document extraction and policy reasoning workflows with explicit decision tracing.
Built exception-handling interfaces so reviewers could override, approve, or escalate decisions.
Added analytics for model confidence, cycle time, and exception categories to support tuning.
Controls and delivery rhythm
A governance model combined policy controls, audit logs, and human override checkpoints, with risk and compliance validating the operating thresholds before broader rollout.
Claims operations gained higher throughput and a stronger customer experience with controlled risk exposure, while reviewers spent more time on complex cases instead of repetitive data entry.
Results and next steps
92% straight-through processing and faster cycle times across high-volume lines.
Upcoming releases include expanded claim-type coverage, fraud-pattern intelligence, and deeper policy recommendation support.
Have similar architecture bottlenecks?
We can map the same modernization pattern to your infrastructure, release process, and operating model.