Claims settled in hours, not weeks.
Sprout.ai is transforming insurance claims processing with AI. Pinnasys built the intelligent automation layer that handles 90% of claims queries automatically — reducing resolution from weeks to just 2.1 hours on average.
90%
Queries automated
2.1 hrs
Avg resolution
The Problem
Insurance claims are slow, manual, and frustrating for everyone.
Insurance claims processing is one of the most document-heavy, rule-intensive workflows in any industry. Policyholders file claims expecting quick resolution. Instead, they wait days or weeks while claims handlers manually review documents, verify coverage, cross-check policy terms, and route approvals through multiple teams.
Sprout.ai set out to change this. Their vision: use AI to automate the majority of claims queries and reduce resolution time from weeks to hours. But the challenge was significant — insurance claims involve complex documents, strict regulatory requirements, nuanced policy language, and high-stakes decisions where errors have real financial consequences.
They needed an AI engineering partner who could build automation that was not just fast, but accurate, auditable, and compliant with insurance regulations.
Our Approach
Most claims automation solutions stop at document extraction — pulling data from forms and PDFs. We went further. Pinnasys built an intelligent claims processing pipeline that doesn’t just read documents — it understands claims context, checks coverage against policy terms, classifies claim types, and routes decisions through the right approval workflows.
The system handles straightforward claims end-to-end with no human involvement. Complex or edge-case claims are escalated to human handlers with pre-analysed summaries, relevant policy excerpts, and recommended actions — turning a 30-minute review into a 5-minute decision.
Every automated decision is logged with full audit trails, making the system not just faster but more transparent than manual processing.
Intelligent document extraction
AI reads and extracts structured data from claim forms, invoices, medical records, photos, and supporting documents — regardless of format or quality.
Automated coverage verification
The system cross-references claim details against policy terms to verify coverage, exclusions, and limits — instantly flagging discrepancies or gaps.
Conversational claims queries
Policyholders and handlers can query claim status, coverage details, and required actions through a natural language interface — no more waiting on hold.
Smart routing & workgroup management
Claims are automatically classified, prioritised, and routed to the right team with task queues, SLA tracking, and workgroup activity dashboards.
The product in action
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
Services used in this project
.
Three things that made this project work.
Audit trails build trust faster than accuracy metrics
Insurers need to see how every decision was made. Building comprehensive logging and explainability from day one accelerated adoption far more than improving accuracy by another percentage point.
Automate the decision, not just the data extraction
Most claims automation stops at pulling data from documents. The real value is in understanding coverage, classifying claim types, and making routing decisions — that is where hours become minutes.
Human escalation is a feature, not a failure.
The best claims automation knows when it does not know. Routing complex cases to humans with pre-analysed summaries made the human handlers more productive, not less.
What this looks like when it's working.
The AI engine that turns cold emails into revenue
3x
Revenue growth
10x
Deals closed
Your digital workforce that never clocks out
168 hrs
Weekly capacity
4x
Human capacity
Have a similar challenge? Let’s talk.
Book a discovery call and we will discuss how AI can automate your document-heavy workflows — with realistic timelines and outcomes.