That’s where insurance claims automation enters the picture. And when you layer in AI in claims processing, you move from “good enough” to truly intelligent, scalable operations.

So, let’s cut to the chase and answer the question you came here for: how do you automate claims processing?

First, let’s define IT process automation: it’s the use of technology to perform repetitive tasks and workflows with little to no human input. 

A great example of IT process automation is direct deposit for paychecks. Thanks to technology, there is no longer manual labor required to print and sign checks, mail them, or for the recipient to make a trip to the bank every week. It’s all automated and taken care of without anything thinking twice.

In insurance, claims processing automation applies IT process automation to everything from First Notice of Loss (FNOL) to final settlement. Automated claims processing systems evaluate, verify, and decide on claims using predefined rules and real-time data. No back-and-forth. No mystery.

With platforms like EIS ClaimCore® and ClaimSmart™, insurers get end-to-end claims automation. From AI-enhanced fraud detection to personalized claimant communications, everything moves faster and cleaner​​.

The typical claims workflow includes:

1. 1. Claim Intake or FNOL (First Notice of Loss) – The moment a customer reports a loss or makes a claim, your automated claims processing system kicks into gear. Digital intake tools collect structured and unstructured data (photos, videos, forms, even voice inputs) and validate it in real time. This results in fewer follow-ups and less manual cleanup downstream​.

   2. Claims Processing – Once the claim is logged, automated workflows take over. Policy validation, damage assessment, documentation tracking, communications are all orchestrated behind the scenes with claims processing automation. This reduces adjuster workload while keeping the customer informed.

   3. Fraud Detection – As soon as a claim is registered and as more data is added, AI tools like ClaimGuard™ go to work. They analyze the claim across hundreds of data points to detect suspicious patterns or inconsistencies, catching potential fraud ASAP​​.

   4. Case Management – Not every claim is simple. When things get complex and third-party involvement, legal reviews, and/or subrogation, automated case management ensures tasks are assigned, tracked, and completed without delay. You get visibility, accountability, and consistency across the entire claims management lifecycle, so even complex claims can be closed faster​.

   5. Payout & Settlement – Once a claim is approved, the payment process is handled automatically. Funds are transferred, receipts are tracked, and confirmations are sent without bottlenecks or manual intervention.

Each step benefits from IT process automation, reducing friction, increasing accuracy, and freeing up humans for actual human work​.

Here’s where things get interesting. Claims processing using AI doesn’t just mean making things faster, it means making them smarter.

Gen AI in claims processing can:

AI insurance claims processing isn’t a one-and-done automation setup. It’s adaptive technology that learns and improves every step of the process, making it smarter over time.

Across lines of business, IT process automation in insurance looks like this:

1. 1. Identify manual work – Whether it’s policy setup, billing reconciliation, customer service requests, or claims handling, automation in insurance starts by mapping out the processes where people are doing tasks that don’t require judgment or strategy, and can therefore be automated.
   2. Define rules and triggers – Determine the logic that governs how those tasks should be executed, likecoverage rules, billing schedules, underwriting guidelines, regulatory checks, etc. These become the “brains” behind your automation.
   3. Design workflows – Build step-by-step processes that move tasks forward automatically, according to the business rules and triggers defined. (This is a lot of work, but worth it in the end.) These can be triggered by events (like a claim submission or a missed payment) and include escalations, alerts, and document handling.
   4. Connect your data – Automation is only as good as the data feeding it. That means integrating your automation tools with policy systems (if they’re legacy or not connected to a modern core platform), CRM tools, third-party data sources, and internal platforms to create a unified, real-time view.
   5. Monitor and improve – Use analytics to track workflow performance, identify bottlenecks, and adapt rules as business needs or regulations evolve. Smart automation is never “set it and forget it.”

However, the quality of all of this hinges on one thing: your core system.

Most traditional and “modern legacy” systems weren’t built for true automation, especially when any kind of decision-making is involved. They’re too rigid, siloed, and dependent on manual workarounds. If your platform can’t respond in real-time, automation becomes more pain than progress.

That’s why a flexible, cloud-native platform like EIS OneSuite™ makes a difference. It’s built for automation, with open APIs, configurable workflows, and the scalability to support everything from underwriting to servicing to insurance claim automation.

When you have a solid core system, you can implement workflows for things like:

• Automated underwriting based on real-time risk scoring

• Billing automation that handles invoicing, payments, and delinquency rules

• Customer portals that respond dynamically to user activity and lifecycle stage

• AI insurance claims processing that detects fraud and accelerates resolution

Claims AI tools go beyond just processing claims, they can help manage them too.

AI insurance claims management isn’t just about tracking claim status, it’s about improving every step that follows. ClaimPulse from EIS uses AI on data captured during FNOL to drive smarter downstream processing. That means faster decisions, fewer delays, and a smoother experience for both claimants and claims teams.

Meanwhile, ClaimGuard keeps tabs on fraud risks. It flags inconsistencies instantly and can adjust workflows without the need for a giant investigation team to comb through every detail.

So, how do you automate claims processing? With the right systems, tools, and mindset.

You can start by eliminating friction at FNOL, then layer in smart automation through every step of the claim. AI claims solutions can take over the time-wasting stuff while your people focus on what matters. 

EIS is built to enable this, and whatever comes next. If you’re ready to get serious about insurance claims automation, check out how we help insurers automate and transform their claims operations in our claims automation use case.