Digital FNOL and claims processing platform with automated triage, straight-through processing for low-complexity claims, real-time status tracking, and integrated fraud scoring — settling claims 70% faster and saving $4M annually in processing costs.
Pinnacle P&C's claims process was entirely phone-based. Claimants called a contact centre for First Notice of Loss (FNOL), waited on hold, spoke to an agent who typed the claim into Guidewire, and then received no updates for days. SLA breach rate on low-complexity claims was 34%. Customer satisfaction was 61% — the lowest in their competitive set.
We built ClaimFlow in 16 weeks: a digital FNOL portal, automated triage and routing engine, straight-through processing (STP) for simple claims under $5K, real-time customer tracking via SMS, and a fraud scoring integration — transforming claims from their biggest liability into a competitive differentiator.
Every claim started with a phone call. Average handle time at FNOL was 45 minutes. During weather events, hold times exceeded 3 hours. Claimants were reporting claims days after the incident out of frustration with the intake process.
Pinnacle handled 8 claim types (auto, property, liability, medical, commercial, marine, travel, umbrella) routed to 140 adjusters by specialty and geography. Mis-routing — which happened in 22% of cases — caused average delays of 4 additional days per claim.
Guidewire ClaimCenter was the system of record, but it ran on an on-premise version from 2011 with no REST API. All integrations were via direct database writes — fragile, unsupported, and a compliance risk on every audit.
The existing rules-based fraud detection was flagging only 4.2% of fraudulent claims. Estimated annual fraud leakage was $3.1M. The SIU team was working high-volume low-yield referrals with a 78% false positive rate.
After submitting a claim, claimants had no way to check status other than calling the contact centre. The result was a flood of inbound "status check" calls consuming 34% of adjuster time — time that could have been spent settling claims.
Simple claims — small auto dents, minor property damage under $5K — were queuing behind complex commercial claims in the same adjuster workflow. A simple claim that should settle in 24 hours was averaging 11 days — breaching SLA in one-third of cases.
Built a web and mobile FNOL portal allowing claimants to submit claims in under 8 minutes with photo upload, location tagging, and guided question flows by claim type. Digital FNOL reduced average intake from 45 minutes to 7 minutes and eliminated hold time entirely.
Built an ML triage engine classifying incoming claims by type, complexity, value band, and geography, then routing to the optimal adjuster from a pool of 140 specialists. Mis-routing dropped from 22% to 2.1%, eliminating 4-day average delays on routed claims.
Built a REST adapter layer on top of Guidewire ClaimCenter's database, exposing a clean API for all claim operations. Bi-directional sync via webhooks ensures both systems are always in sync. No direct database writes — all operations go through the adapter with full audit logging.
Integrated an ML fraud scoring engine analysing claim characteristics, claimant history, social signals, and photo metadata. Every incoming claim receives a fraud score in under 200ms. High-risk claims route to SIU with an automated evidence pack — reducing false positives from 78% to 19%.
Built a customer-facing claim tracker with SMS and email updates at every stage: FNOL received, adjuster assigned, inspection scheduled, settlement offered, payment issued. Status-check inbound calls dropped 71% within 90 days of go-live.
Built an STP engine for low-complexity claims under $5K — automated assessment using submitted evidence, automated settlement calculation, and payment trigger via ACH — all without adjuster involvement. 38% of claims now settle within 4 hours of FNOL with zero human touch.
First 10,000 claims processed digitally. SLA breach rate dropped from 34% to 9%. Digital FNOL adoption at 78% within 6 weeks of launch — no marketing push required. Status-check inbound calls down 40% already.
70% reduction in average settlement time. $4M annualized processing cost savings. Fraud detection rate improved from 4.2% to 18.7%. The SIU team working 3x fewer referrals but with 4x the conviction rate.
Customer satisfaction score reached 94% — up from 61% and now the highest in Pinnacle's competitive set. ClaimFlow expanded to 3 additional product lines. Pinnacle's claims operation won a regional InsurTech excellence award.
"ClaimFlow transformed claims from our biggest customer pain point into a competitive advantage. Settlement times are down 70%, our fraud detection is 4x more effective, and customer satisfaction jumped from 61% to 94%. The Digivance team understood insurance operations — not just software. They knew what straight-through processing meant for our P&L before we had to explain it."
Ready to transform claims operations and turn a cost centre into a customer experience advantage?