We Automated 90% of Claims Queries for an InsurTech Leader
Sprout.ai is changing how insurers handle claims. Pinnasys built the AI automation layer that resolves 90% of claims queries on its own, cutting average resolution time from weeks to 2.1 hours.
90%
Queries automated
2.1 hrs
Avg resolution
The Problem
Insurance Claims Are Slow, Manual, and Frustrating for Everyone
Claims processing is one of the most document-heavy, rule-intensive workflows in any industry. Policyholders expect a quick resolution. Instead, they wait weeks while handlers review documents, verify coverage, and route approvals by hand.
Sprout.ai set out to automate the majority of claims queries and cut resolution from weeks to hours. The challenge was real: complex documents, strict regulations, nuanced policy language, and decisions with financial consequences.
They needed an AI engineering partner who could build automation that was not only fast but also accurate, auditable, and compliant with insurance regulations.
Our Approach
Custom AI That Reads, Verifies, and Routes Every Claim
Most claims automation stops at document extraction. We went further. Pinnasys built an intelligent claims processing pipeline that understands context, checks coverage against policy terms, classifies claim types, and routes decisions through the right workflows.
The system handles straightforward claims end-to-end with no human involvement. Complex cases escalate to handlers with pre-analyzed summaries, relevant policy excerpts, and recommended actions, turning a 30-minute review into a 5-minute decision.
Intelligent Document Extraction
AI reads and structures data from claim forms, invoices, medical records, and photos, whatever the format or quality.
Automated Coverage Verification
The system cross-references claim details against policy terms to confirm coverage, exclusions, and limits, flagging gaps instantly.
Conversational Claims Queries
Policyholders and handlers check claim status, coverage, and next steps through a natural language interface. No more waiting on hold.
Smart Routing & Workgroup Management
Claims are classified, prioritized, and routed to the right team, with task queues, SLA tracking, and activity dashboards.
Speed and Compliance, Measured in Real Results
Claims Settled in Hours, Not Weeks.
90%
Of claims queries fully automated without human intervention
2.1 hrs
Average resolution time — down from days or weeks
Full
Audit trails on every automated decision for regulatory compliance
5 min
For complex claims that previously took 30+ minutes to review
CTO — Sprout.ai — InsurTech Platform
Three Things That Made This Project Work
Audit Trails Build Trust Faster Than Accuracy Metrics
Insurers need to see how every decision was made. Comprehensive logging and explainability from day one drove adoption more than any other point of accuracy.
Automate The Decision, Not Just The Data
The real value is in understanding coverage, classifying claims, and routing them. That is where hours become minutes.
Human Escalation Is A Feature, Not A Failure
The best claims automation knows what it does not know. Routing complex cases to handlers with pre-analyzed summaries made them more productive, not less.
Let's Build Your Intelligent Automation Layer Together!
Tell us the workflow that drowns your team in paperwork. We'll show you how production-ready AI could carry it, accurately and auditably. No pitch, just a clear read on what's possible.