The business
Larkfield Mutual is a mid-sized property and motor insurer with customers in the United States and the European Union. It receives about 18,000 new claims a month (first notice of loss).
How intake works today
| Channel | Share | What arrives |
|---|---|---|
| 60% | A free-text description, often with photos and attachments | |
| Web form | 30% | Structured fields plus uploaded photos and documents |
| Scanned post | 10% | Handwritten or printed forms, sometimes with medical reports |
Fourteen intake handlers read each claim, key 31 fields into ClaimsCore (the claims system of record), check that the policy was active on the date of loss, request any missing documents, and send an acknowledgement to the customer.
Measured baseline (last quarter's operations data):
- Average handling time: 22 minutes per claim.
- Keying errors: 6% of claims have at least one wrong field (from a monthly quality sample of 400 claims). Each error takes 35 minutes of rework later.
- Acknowledgement SLA (within one business day): met 81% of the time. Target: 98%.
- Loaded handler cost: $48 an hour.
What Larkfield is considering next
- Fast-track for small motor glass claims. About 2,400 windscreen claims a month, averaging $420, almost never disputed. Claims operations wants them paid within a day when the policy covers glass, instead of the current five days.
- Claim prioritization. A queue score so that the most urgent claims (injuries, uninhabitable homes) reach adjusters first.
Systems
| System | Role | Notes |
|---|---|---|
| ClaimsCore | System of record for claims | REST API for creating and updating claims |
| Policy Admin | Policy status, cover and limits | API, 95th-percentile response 300 ms |
| Fraud rules engine | Scores each claim against fixed rules | Owned by the Special Investigations team |
| Document store | Holds every attachment | Retains documents for 7 years |
Data and regulation
- Claims contain personal data; injury claims also contain health information from medical reports.
- EU claimants are covered by GDPR; their data must be processed in the EU. US customers' data stays in the US.
- The regulator does not allow automated claim denials: a licensed adjuster makes every denial decision. Payouts over $10,000 need a senior adjuster's approval.
Size of the inputs
- A typical claim package is about 9,000 tokens; the 95th percentile is 40,000 tokens (long medical reports). 95% of packages are under 20 pages; the longest run to about 120 pages.
- The extraction instructions and the 31-field schema add a stable 4,000 tokens to every request.
- A drafted acknowledgement is about 1,200 tokens of output including the extracted fields.
People
| Stakeholder | Cares most about |
|---|---|
| VP Claims Operations (sponsor) | The SLA and handling time |
| Head of Compliance | Regulator rules, audit evidence, GDPR |
| Claims IT lead | ClaimsCore integration, support load |
| Intake team lead | Workload, quality, how the team's role changes |