---
# AI-based claims automation drives 85% straight-through approval
**URL:** https://www.sigmoid.com/case-studies/ai-based-claims-automation-drives-85-straight-through-approval/
Date: 2026-09-22
Author: Joha Momin
Post Type: page
Summary: Insurance·Property & Casualty·Claims Automation Interactive Case Study AI-based claims automation drives 85% straight-through approval A multi-line P&C insurer processed auto and property...Read More...
---
Insurance*·*Property & Casualty*·*Claims Automation
Interactive Case Study
# AI-based **claims automation** drives *85% straight-through approval*
A multi-line P&C insurer processed auto and property claims on a legacy monolith where every claim, however simple, waited in one manual queue. Sigmoid rebuilt the lifecycle as four coordinated microservices spanning intake, assessment, policy, and payment, achieving **85% auto-approval**, **72-hour settlement** on simple claims, and a **30% reduction** in processing cost across the book.
Manual Claims Handling at Scale, The Before State
What adjusters faced before automation
Claims routed through manual review
Full book
**
Straight-through processing coverage
None
Adjuster capacity for complex claims
Low
Simple and complex claims shared a single queue, so every settlement waited on human judgment and cycle times stretched to weeks.
Manual
keyed entry
from documents
Slow
weeks to settle
a simple claim
Costly
rising cost
per claim
### The business scenario
### A manual claims lifecycle that couldn't keep pace
The insurer processed auto and property claims through a legacy, monolithic system that leaned heavily on manual review. Every claim — however simple — waited in the same queue behind complex ones. As volumes climbed, cycle times stretched to weeks, operating costs rose, and settlement decisions varied from one adjuster to the next.
C1
#### Manual document handling
Adjusters keyed data by hand from PDFs, forms, and damage photos. Extraction was slow, inconsistent, and prone to error before assessment even began.
C2
#### Slow, uneven assessments
Damage evaluation and settlement amounts depended on individual judgment. Simple, low-value claims sat behind complex ones, pushing cycle times to multiple weeks.
C3
#### Costly, hard-to-audit operations
Fragmented systems drove up per-claim cost and made it difficult to produce a complete, traceable record for regulators across the claim lifecycle.
Before · average claim cycle time by stage
Intake & entry
~2 days
Assessment
~6 days
Policy checks
~1.5 days
Approval queue
~4 days
Payment
~1 day
Simple and complex claims shared one manual queue — a **single bottleneck** for the whole book.
### Sigmoid's solution
### End-to-end claims automation, built on microservices
Sigmoid built a claims platform that decomposes the lifecycle into independent services — intake, assessment, policy, and payment — coordinated by an event-driven workflow. Simple claims flow through untouched, while complex ones route cleanly to human adjusters, with a complete audit trail behind every decision.
Claims automation architecture
Claimant
Docs · photos
FNOL forms
Claims Intake
Service
Document upload
OCR extraction
Data validation
Assessment
Service
ML damage eval
Repair-cost model
Image recognition
Policy
Service
Coverage checks
Limits & deductibles
Eligibility rules
Payment
Service
Settlement calc
Disbursement
Payout routing
Event-driven workflow orchestration · Saga pattern (Camunda + Apache Kafka)
EXTERNAL INTEGRATIONS
Image recognition APIs
Repair shop networks
Medical providers
Audit trail · full decision traceability
### Workflow orchestration
A Saga pattern coordinates long-running claims. Each step emits an event that triggers the next, with built-in compensation logic that rolls back cleanly when a step fails.
### External integrations
Live connections to repair shop networks, medical providers, and image recognition APIs bring third-party estimates and evidence directly into assessment.
### Compliance & audit
Every claim decision, approval, and payment is logged with full traceability — producing a complete, regulator-ready audit trail across the lifecycle.
Technology stack
ML / AI
TensorFlowOpenCV
Document processing
Tesseract OCRAWS Textract
Workflow engine
CamundaApache Kafka
### How a claim flows
### Claim submission workflow
Each stage triggers the next through an event, orchestrated by the Saga pattern. Submit a simple claim to watch it settle end-to-end — no adjuster required.
Press "Submit claim" to run the workflow
Claim **CLM-4821** · Auto · minor collision · est. $2,140
Reset
Submit claim
STEP 01
##### Document upload → validation
Photos and FNOL forms uploaded; files validated for completeness.
STEP 02
##### OCR extraction → assessment
Textract and OCR pull structured fields and hand off to assessment.
STEP 03
##### ML damage analysis → approval
Damage and repair cost scored; within limits, the claim clears review.
STEP 04
##### Payment calculation → settlement
Settlement computed against policy and disbursed to the claimant.
event bus · kafka
Waiting for submission. The claim sits idle until an event kicks off the workflow.
*Illustrative
### Business impact
0%
of claims auto-approved through straight-through processing
Automating the end-to-end lifecycle cleared the manual bottleneck, freed adjusters to focus on complex cases, and lifted customer satisfaction to a **4.5★** rating on claim experience.
### 72 hrs
Settlement time for simple claims, down from weeks in the manual queue.
### 30%
Reduction in claims processing cost across the book of business.
### About Sigmoid
Sigmoid combines data engineering and AI consulting to help enterprises gain a competitive advantage through effective data-driven decision-making. We partner with insurers and other data-intensive businesses to modernize core operations — turning fragmented, manual workflows into automated, auditable systems built on cloud-native architecture.
From claims automation and document intelligence to ML-driven assessment and event-driven orchestration, Sigmoid delivers production platforms that scale with the business.
### Modernizing claims operations?
Talk to our team about automating your claims lifecycle with straight-through processing and full auditability.
Start a conversation
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