ClaimsOS reads every document, rebuilds the shipment timeline, compares the certificate against the master policy, estimates indemnity, flags fraud signals — and hands the adjuster a 1-page Decision Brief.
AI checks every document. A human always makes the final decision.
ClaimsOS never auto-settles a claim. Every AI finding is presented to a qualified adjuster who approves, overrides or escalates — with a full audit trail of who decided what and why.
25+ automated checks on coverage, packing, Incoterms, indemnity, fraud and timeline — with evidence linked to the source page.
The adjuster always decides. AI proposes findings, recommendations and a draft settlement — a person reviews, approves or overrides.
Approvals, rejections and tier escalations are tracked with reason and user. The Decision Brief shows what the AI said and what the human chose.
Real scenarios showing how ClaimsOS routes, reads, validates and decides — with the adjuster in control at every step.
Warehouse ERP pushes claim via API. Rule: country = USA → New York branch queue.
AI reads B/L, commercial invoice, damage photos and certificate of insurance.
Coverage matches. Packing adequate. No underinsurance. Severity: moderate.
Repair estimate $42,000. Deductible $500. AI suggests settlement $41,500.
Adjuster reviews 1-page brief with evidence links. Approves in 4 minutes.
Capped discharge sent to customer. E-signature via portal. Funds released.
Trucker emails subject 'Theft CLM-2026-001200' + police report. IMAP matches to claim.
Certificate vs policy wording: clause 4.2 excludes unattended vehicle theft.
Incoterm CIP — risk transferred to buyer at loading. Carrier Bailee liability applies.
Geo-cluster alert: 3 thefts on same route in 30 days. Signal flagged for review.
Senior adjuster overrides fraud signal (police report solid). Rejects claim — directs to carrier.
Rejection reason logged. Customer notified. Subrogation pack prepared automatically.
Consignee uploads photos and packing list via branded portal. Magic-link auth.
AI cross-checks: 120 cartons received vs 125 on B/L. Shortfall = 5 cartons.
Underinsurance detected: insured value is 80% of invoice. Deductible applies.
Invoice $5,000 × 80% coverage = $4,000 capped settlement. Deductible $250. Payable $3,750.
Adjuster sees underinsurance note + photo evidence. Approves capped amount in 3 minutes.
Discharge letter explains deduction. Customer signs. Settlement wired. Closed.
Set each policy to Internal, Delegated or Hybrid handling. When a claim is delegated to an external loss adjuster, the principal keeps a live, read-only view of the entire file.
Each policy carries its own handling mode — Internal, fully Delegated to a named adjuster workspace, or Hybrid (e.g. delegate above a value threshold). The rule is snapshotted on every new claim so the audit trail never drifts.
The insurer or MGA sees every delegated claim in real time: status changes, AI Decision Brief, uploaded documents, timeline events, indemnity estimate, discharge form and external communications — without altering the adjuster's work.
Adjusters only see claims explicitly delegated to their workspace. Internal claims stay invisible to external parties. Tenant isolation is enforced at the database level — so the boundary holds for API, SDK and exports too.
Every pick, assignment, escalation, status change, document upload, settlement proposal and outbound email by the adjuster is logged. The principal can reconstruct exactly who did what, when, and on which version of the file.
Keep small or simple claims in-house and automatically delegate the complex or high-value ones. The same policy can route a 5,000 EUR shortfall in-house and a 250,000 EUR engine failure to a specialist TPA — automatically.
Switch delegation on or off at any time — existing claims keep the rule that applied when they were created, new claims follow the new rule. No retroactive changes, no silent reassignments, no orphan files.
Add the ClaimsOS claim experience directly into your own website or app. Your customers stay on your site, your team receives everything in the ClaimsOS workspace — no redirect, no separate login.
The SDK inherits your tenant colours and logo. To your customer it looks like part of your portal — because it is. You choose which components appear: claim form, document upload, status tracker, chat and communication.
ClaimsOS never asks your customer to log in. Your system authenticates the user, signs a secure JWT token, and passes it to the SDK. ClaimsOS verifies the signature and instantly knows who the customer is.
Drop the SDK script onto any page — plain HTML, React, Vue or Angular. Configure components in the SDK Studio, copy the generated snippet, and publish. Data flows straight into your ClaimsOS workspace.
A customer uploads a document via the embedded widget → it lands in the correct claim file in your workspace → AI extracts, validates and scores the file → your adjuster opens the 1-page Decision Brief and decides.
Everything every cargo claim needs — ingested, structured and validated automatically.
Beyond extraction — the platform reasons over coverage, liability, indemnity and fraud, with evidence trails linking every finding to the underlying document.
Adjusters understand every claim — risks, evidence, recommendation — in under 5 minutes.
Field-by-field comparison of insurance certificate against the master policy wording.
Who is liable based on Incoterms, transfer of risk and carrier responsibility.
Suggested settlement range with deductibles, salvage and underinsurance applied.
Cross-claim signals: repeat claimants, geo-clusters, document anomalies.
Damage severity, packing adequacy and authenticity scored from claim photos.
Auto-rebuilt chronology from documents and emails for fast situational awareness.
Reuse clause-to-outcome mappings from previously approved claims.
Triage, assignment, approvals, communications and audit — all built into the file.
Priority score and triage level escalate high-value or high-fraud claims automatically.
Round-robin assignment by adjuster load with SLA timers and breach alerts.
Sequential review chain — Adjuster → Senior → Insurer — for high-value files.
Per-user SMTP, attributed inbound mail, AI-rephrased external comments.
In-app, email, Slack and Teams alerts with daily digest support.
Who did what, when — full audit trail with CSV export for compliance.
Plug ClaimsOS into your stack with a public REST API, webhooks and an embedded portal — with strict row-level tenant isolation.
Loss ratios, hot routes, repeat claimants, broker scorecards across the book.
Tenant-scoped API with OpenAPI 3.1 spec for claims, documents, briefs and reports.
Tenant and claim-level outbound delivery with retries for downstream systems.
Magic-link authenticated portal for claimants to upload documents and track status.
Row-level tenant isolation, role-based access and hardened storage policies.
Claim-aware chat assistant grounded in the file's documents and findings.
The newest update adds intelligent claim routing into branch queues, geographic scoping, an expert directory with real-time chat, capped discharge & subrogation, and approval logic on every AI finding.
New claims land in the right branch queue and are picked atomically — tier-gated assignment prevents low-authority handlers from grabbing files above their limit.
Inbound API claims are routed to a branch using configurable rules on country, commodity, value and source — with a clean audit trail.
Members only see claims in their assigned branches/countries. Only the workspace Owner has worldwide visibility.
Each team member has an authority level (1–5) and a max claim value. Higher claims escalate to senior reviewers automatically.
Find experts, chat in real time with auto-translation, and grant temporary full-claim access with countdown and audit log.
Capped settlement, customer e-signature via secure portal, subrogation pack one click away.
Senior reviewers approve or override individual risk signals — the fraud score and rating recompute live, excluding cleared signals.
Address book by category, per-tenant SMTP and subject-based IMAP attribution to the right claim.
Tenant logo, colors, custom subdomain, branded PDFs and portal — plus Stripe-powered plans.
Start free for 14 days. Upgrade when you're ready — change plans, cancel or contact sales any time.
Multi-branch operations — full AI suite, SMTP/IMAP, REST API, webhooks, basic SDK.
Claims operating system — unlimited everything, full white-label, custom domain, SSO.
All plans include AI intelligence, multi-tenant isolation and SSL. Prices in USD, excl. tax.