Claims intake triage and document handling for an insurance provider

Client context

A general insurance provider receives claims through email, a portal and a call centre. Handlers open each submission, identify the claim type, check whether the required documents are attached, and request anything missing. Only then does assessment begin.

The challenge

The pre-assessment work is substantial and repetitive, and incomplete submissions cause several rounds of correspondence before assessment can start. Regulatory obligations require that claim decisions remain with authorised handlers, so automation cannot extend to adjudication. Any solution must produce an audit trail suitable for regulatory review.

Objectives

• Reduce manual classification and document-checking effort at intake
• Identify incomplete submissions immediately rather than after a handler opens them
• Keep every claim decision with an authorised human handler
• Produce an audit trail suitable for regulatory review
• Route sensitive circumstances to people by rule, not by model judgement

The solution

Submissions from all channels are normalised into a single intake queue. Document Intelligence extracts structured fields from common claim documents; a classification step assigns claim type and identifies missing mandatory documentation. Where a document is missing, an automated request is issued with the specific items required. A Copilot Studio agent supports handlers with case summarisation and policy reference lookup grounded in approved documentation. Adjudication remains entirely with authorised handlers, and every automated action is logged with inputs and confidence.

Architecture

• Dynamics 365 Customer Service as the claims handling workspace
• Azure AI Document Intelligence for structured extraction from claim documents
• Power Automate for channel normalisation, completeness checks and correspondence
• Copilot Studio agent for handler-side summarisation and policy lookup, grounded on approved content
• SharePoint Online for claim documentation with retention labelling
• Dataverse audit and custom action logging for regulatory evidence
• Rule-based bypass routing sensitive circumstances directly to specialist handlers