Claims Processing and Investigations

Claims Are the Moment of Truth in Insurance. They Are Also the Highest-Cost, Highest-Fraud-Risk Operation an Insurer Manages.

Bandhan Technologies’ claims processing and investigations platform combines Agentic RAG-driven processing automation with embedded multi-entity relationship graph intelligence, driving higher productivity in claims operations and sharper fraud detection across the full claims lifecycle.

Claims Operations Are Slow, Expensive, and Fraud-Exposed

Insurance claims operations face three compounding challenges: high volumes and labour costs driven by manual processing, increasingly sophisticated claims fraud, and rising customer expectations for faster resolution. The average property and casualty claim takes 15 to 30 days to close. Fraudulent claims account for 10 to 15% of all insurance payouts in the US. Customers who experience poor claims service are also five times more likely to churn at renewal.

What Is the Claims Processing and Investigations Platform?

The claims processing and investigations platform is a dual-capability AI solution. An Agentic RAG layer drives claims processing automation and adjuster productivity, while a multi-entity relationship graph powers fraud prediction and investigation path optimisation.

Claims Processing Capabilities

Agentic Claims Triage

AI agents automatically classify incoming claims, extract key information from FNOL submissions, and route claims to the appropriate processing workflow.

Document Intelligence

Automated extraction and analysis of claims documentation including police reports, medical records, repair estimates, and photographs, using multi-modal AI.

Straight-Through Claims Processing

Standard, low-risk claims meeting defined criteria are processed and settled automatically without adjuster intervention.

Adjuster Augmentation

For claims requiring human review, AI surfaces a complete investigation brief including summarized documentation, coverage analysis, comparable claim benchmarks, and recommended settlement range.

Customer Communication Automation

Proactive, personalized claim status updates are delivered across the customer’s preferred channel, reducing inbound status inquiries by 60%.

Fraud Detection and Investigation Capabilities

Multi-Entity Relationship Graph

A graph database maps relationships across claimants, service providers, medical professionals, repair shops, attorneys, and prior claims, revealing organized fraud rings that are invisible to transactional analysis.

Fraud Prediction Models

ML-based scoring of every incoming claim for fraud risk indicators, including behavioral anomalies, network signals, and historical pattern matching.

Shortest-Path Investigation

Graph algorithms identify the most efficient investigative path to confirm or dismiss fraud suspicion, reducing SIU investigation time.

Incremental Network Intelligence

As new claims arrive, the graph continuously updates network connections and refines fraud risk scores for existing open claims.

Business Impact

30 to 40%

more cases handled per analyst per month

25 to 30%

more cases handled per analyst per month

80%

more cases handled per analyst per month

60 to 70%

reduction in manual data-gathering time per case

Technical Architecture

Step 1

Step 2

Step 3

Step 4

Step 5

Agentic Orchestration A multi-agent framework coordinates claims intake, document processing, adjudication, and communication workflows autonomously.

Multi-Modal AI Layer

Processes text, images, PDFs, and structured data from the full spectrum of claims documentation.

Graph Intelligence Engine

A purpose-built insurance fraud knowledge graph with entity resolution, relationship inference, and real-time update capabilities.

Core System Integration

Pre-built connectors for leading property and casualty claims platforms including Guidewire, Duck Creek, and Majesco, and medical billing systems.

SIU Workflow Module

A dedicated investigation workflow for the Special Investigations Unit covering case management, evidence tracking, and referral automation.

Claims Processing and Investigations