›Why claims automation dominates 2026 insurtech
A typical P&C claim touches a dozen handoffs before closure — FNOL, coverage check, document intake, reserve setting, liability assessment, vendor coordination, payment authorization. In 2026, leaders chain these into a single orchestrated workflow.
Utilyx models this journey as connected BPM nodes: the claim is captured, the AI copilot pre-maps the regulatory steps, and every decision is logged for audit.
›The automated claims workflow
- First notice of loss: structured intake of the incident, parties and damages.
- Coverage verification: automatic check against the policy terms and conditions.
- Document intake: photos, estimates and police reports attached and OCR-processed.
- Conditional routing: simple claims auto-route to fast-track; complex ones escalate to an adjuster.
- Reserve setting and liability: automated proposal, adjuster validation.
- Payment authorization: multi-level approval, automatic settlement PDF, legal archiving (useArchive).
- Notification: claimant and agents receive a traceable confirmation.
›Concrete benefits for insurers
Insurers report up to 75% faster claims resolution, a sharp drop in manual handoffs, and a complete audit trail — the workflow blocks progression until required documents and validations are present.
The insurance vocabulary (FNOL, reserve, adjuster, subrogation, deductible, indemnity) is native to the platform, so the copilot proposes the right schema without re-explanation.
›The workflow in real time
Every node is executable, every branch is testable. Visualize the actual flow of your data while you design.
›Measured gains after automation
Temps de règlement sinistre
Before
15 jours
After
3 jours
Taux de fraude détectée
Before
2%
After
8,5%
Coût par sinistre
Before
120 €
After
18 €
Satisfaction client (NPS)
Before
32
After
58
›How to automate this process — step by step
Capter la déclaration
Le sinistre est saisi via un formulaire structuré avec pièces jointes (photos, documents) et validation automatique des champs obligatoires.
Routage intelligent
Le workflow route automatiquement vers le bon ajusteur selon le type, le montant et la complexité du sinistre.
Valider et décider
L'ajusteur valide, refuse ou demande un complément — chaque décision est tracée avec horodatage et données en lecture seule.
Générer le document
usePDF produit automatiquement la lettre de règlement, le détail des indemnisations et le récapitulatif client.
Archiver et notifier
useArchive classe le dossier, le client reçoit une notification avec lien direct, et le règlement est tracé de bout en bout.
›Return on investment
Frequently asked questions
Can simple claims be auto-settled?
Yes. Conditional routing sends low-severity claims under threshold to a fast-track path with minimal validation, while complex cases escalate to an adjuster.
Is the claim file auditable end-to-end?
Every node, decision and document is journaled with timestamp and actor; the settlement PDF is archived in a tamper-evident archive.
Ready to automate your processes?
Utilyx lets you design, automate and orchestrate your workflows visually — with an AI copilot, OCR, PDF generation and legal archiving. Start in minutes, not weeks.