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Insurance operations handle high volumes of claims under strict compliance and regulatory requirements. Every claim involves document extraction, policy verification, reserve calculation, and fraud screening — tasks that require pulling data from multiple systems, cross-referencing it, and making time-sensitive decisions. Manual processing is slow, error-prone, and expensive. A missed fraud indicator or a delayed reserve estimate can cost the organization thousands per claim. Wayak connects your claims management system, policy database, and document repositories into a unified data layer. Agents extract information from uploaded documents, verify coverage, estimate reserves from historical data, and flag suspicious claims — all while keeping humans in the loop for final decisions. Playbooks automate the intake pipeline, so new claims are classified and routed within minutes instead of hours.

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Use cases

Claims intake automation

Extract policy numbers, loss details, and supporting documents from submissions and route claims to the right handler automatically.

Reserve estimation

Calculate initial reserve estimates based on comparable historical claims using statistical analysis.

Fraud pattern detection

Score claims against known fraud indicators and flag suspicious submissions for investigation.

Document classification

Identify and categorize uploaded documents — FNOL forms, police reports, medical bills, repair estimates — automatically.

Policy coverage verification

Cross-reference claim details against active policy terms to confirm coverage before processing.

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Platform capabilities used

CapabilityHow it’s used
Data sourcesClaims management system (claim records, claimant history, payment data), policy administration system (active policies, endorsements, exclusions), general ledger (reserve postings)
Knowledge spacesUploaded claim documents (FNOL forms, police reports, medical bills, repair estimates), policy documents, underwriting guidelines, fraud indicator reference materials
Semantic layerObjects for claims, policies, and claimants. Metrics for reserve amount, fraud risk score, average payout, and cycle time. Dimensions for claim type, severity, region, and status
AgentsClaims Intake Analyst for document extraction and routing. Fraud Detection Analyst for risk scoring and investigation recommendations
PlaybooksEvent-triggered claims intake pipeline, scheduled fraud scans, reserve recalculation workflows