AI-Powered Framework for Smarter Claims
What is Claims Intelligence?
Intelligence built around the way your claims team already works
Claims Intelligence is a governed AI layer powering the PCRS claims workflow. It automates routine decisions, surfaces leakage and risk, and routes work to the right adjuster — all inside the system your team already runs claims on.
The result is faster intake, sharper prioritization, consistent policy checks, and governed automation on the work that doesn’t need a human eye — so adjusters stay focused on the decisions that move the loss number.
No parallel tool. No swivel-chair. No engineering tax. Practical AI deployed where it pays back — inside governed workflows, with humans on the exceptions.
Built into PCRS
Embedded in the claims workflows your adjusters already use. Not a bolt-on, not a parallel tool.
Governed by design
Configurable rules, decision receipts, and a complete audit trail on every action. Reversible by default.
Practical AI, not hype
Grounded in PCMI's F&I data — real coverage rules, real failure modes, real servicer behavior. Not a generic copilot.
Why it matters for claims teams
Reduce manual touches on every claim and accelerate authorization and payment.
Increase adjudication consistency with configurable, policy-driven decisions.
Scale claims operations without proportional growth in headcount.
Surface leakage, recall recovery, and risk signals across the portfolio.
Keep adjusters focused on higher-value decisions, not repetitive review.
Maintain operational visibility and policy-driven control at every step.
Explore Claims Intelligence by capability
Three pillars, one governed platform — all available now.
Do The Work
AutomationIQ
~50%
Modeled cycle time reduction on average claim
AutomationIQ
Rules-based AI workflows that orchestrate guarded claims actions — invoice validation, adjudication, authorization, payment, and denial — inside PCRS.
ExploreSee The Truth
InsightsIQ
~30 pts
Modeled loss ratio improvement
Insights IQ
Portfolio analytics, risk scoring, recall recovery, and benchmarking that surface hidden leakage and inform sharper claims decisions.
ExploreRoute The Work
WorkforceIQ
~4 min
Modeled handle time on clean claims
Workforce IQ
Intelligent routing assigns claims by complexity, workload, and expertise — so junior adjusters ramp faster and senior teams focus on what moves the loss number.
ExploreAutomationIQ
Do the work — automatically and accountably
AutomationIQ is a governed orchestration engine that automates the guarded actions inside a claim: validation, adjudication, authorization, payment, denial, and exception routing. Configurable rules. Full audit trail. Adjusters on the exceptions.
- AI invoice validation via IDP — eliminates manual line-by-line review
- One-click AI adjudication with adjuster oversight on every action
- Auto-payment via VCC integrations (Wex, ConnexPay, Corpay, Chase, VPay)
- Configurable rule engine — AND / OR / EQUALS / CONTAINS / BETWEEN
- Embedded actions: pay, note, status change, flag for review
~0%
Cycle time reduction
Modeled - average claim
0%
Photo-upload compliance
Required-photo intake
0%
Fraud abandons at intake
Modeled · legal-ack step
0
Engineering tax
No rebuild required
Authorization & payment automation, quantified.
The two highest-leverage AutomationIQ workflows, measured per 100k claims processed.
Authorization workflows
$210K
annual cost savings
11K hrs
reclaimed annually
85%
time reduction
6 min
saved per claim
Payment workflows
$90K
annual cost savings
5K hrs
reclaimed annually
3x
productivity boost
3 min
saved per claim
InsightsIQ
See the truth behind every claim.
InsightsIQ gives visibility across risk, recovery, servicer performance, and portfolio trends. Lower-touch claims move through straight-through processing, while adjusters focus on higher-value decisions. Leaders gain clarity to improve productivity and catch leakage before it compounds.
- Multi-factor risk scoring across the entire book
- Carfax / NHTSA / TSB / recall lookup integrations
- Labor-rate market benchmarking + parts pricing checks
- Used-vehicle value cap and same-part double-payment block
- Executive-ready insights — no analyst required
~0 pts
Loss ratio improvement
Modeled · early data
$0K+
Annual recall recoveries
Modeled · per TPA
0 pts
From photo AI alone
Loss-ratio contribution
Book-wide
Multi-factor risk scoring
Across the portfolio
WorkforceIQ
Route the right claim to the right adjuster.
WorkforceIQ directs claims by complexity, workload, expertise, and SLA risk — so junior adjusters ramp on appropriately scoped work and senior teams stay focused on the claims that move the loss number.
- Smart routing by skill, product, priority, and SLA risk
- Workload routing by claim complexity
- AI claims-analysis assistant — coverage Q&A with cited contract refs
- Parallel multi-claim workflow + pre-filled authorization screens
- Escalation logic during surges and holiday volume
Higher
Adjuster throughput
Modeled
Faster
Junior ramp time
Scoped routing
Senior
Leverage preserved
Focus on complex claims
Surge
Escalation logic
Peaks & holidays
WHY PCMI
AI is only as strong as the foundation underneath it
PCRS already runs the F&I lifecycle for the industry — the data, the workflow, and the governance no AI startup can replicate.
Deterministic Core
Policy-as-code on PCRS. Logged, reversible, explainable to regulators. Decision receipts on every action — evidence, threshold, timestamp.
The dataset no one else has
48M real F&I claim outcomes — failure rates, servicer behavior, severity. Real coverage rules. Not synthetic benchmarks.
PCMI Single lifecycle system
Contract → claim → payment → reporting on one model. No integration tax. No swivel-chair. No parallel tool to keep in sync.
See Claims Intelligence inside PCRS.
Start with a working conversation about your claims goals, current workflow, and the highest-value capabilities to roll out first. We’ll show you how Claims Intelligence fits the way your team already operates.