AI-Driven Intelligence for Commercial Insurance Claims
QualRisk AI helps Lloyd's managing agents, global insurers, and TPAs identify avoidable losses and optimize claims handling with traceability and evidence-based insights.
5-10% of claim losses are avoidable through better intelligence and oversight
Built for Commercial Insurance
QualRisk AI is a decision intelligence platform purpose-built for the complexity of commercial insurance claims. We help claims teams make better decisions faster by bringing AI-powered audit and insight capabilities that scale with your portfolio.
Built for Insurance
Purpose-built by insurance professionals for the complexity of commercial claims
Lloyd's Expertise
Deep understanding of Lloyd's market dynamics and managing agent requirements
Enterprise Security
ISO 27001 certified with enterprise-grade security and compliance
Seamless Integration
Works with your existing claims systems and workflows, not against them
5-10% of Claim Losses Are Avoidable
Commercial insurance claims teams face mounting pressure: large complex files, inconsistent TPA handling, missed subrogation, fraud indicators buried in hundreds of pages, and coverage errors that slip through review.
Missed Subrogation
Recovery opportunities overlooked in complex multi-party claims
Fraud Indicators
Red flags buried in hundreds of pages across multiple documents
Coverage Errors
Misapplied policy terms and conditions leading to leakage
Weak Litigation Strategy
Inadequate defense preparation and delayed escalation decisions
TPA Inconsistency
Variable handling quality across third-party administrators
Reserve Accuracy
Inadequate or excessive reserves leading to financial surprises
Introducing Claims Pulse
AI-driven claims intelligence and audit platform for commercial insurance. Transform entire claim files into actionable insights with traceability to source.
Intelligent Ingestion
Handles large, messy files (PDFs, emails, images) and structures them for comprehensive analysis
Human-Quality Summaries
Generates concise, accurate summaries of complex claims that read like an experienced adjuster wrote them
AI-Driven Audits
Applies real claims audit frameworks across coverage, fraud, subrogation, reserving, and compliance
Next-Best-Action Insights
Recommends specific actions backed by evidence from the claim file—no black boxes
Portfolio Dashboards
Aggregated view with drill-down to individual claims and supporting evidence at document level
Ecosystem Integrations
Plugs into your existing claims systems, data lakes, and workflows with API-first architecture
From Portfolio to Individual Claim
Drill down from market-level metrics to document-level evidence with full traceability. Every insight backed by source documents.
Portfolio Overview Dashboard
Monitor TPA performance and identify avoidable losses at scale
Overall Metrics
Top 5 Items to Complete
Claim Detail & AI Analysis
Deep dive into individual claims with AI-generated insights and evidence
CP-2024-0012
Hurricane Property Damage - Coastal Manufacturing Facility
AI-Generated Summary
Catastrophic hurricane damage to coastal manufacturing facility with extensive structural damage, machinery losses, and business interruption. Category 4 hurricane caused severe wind damage, storm surge flooding, and complete loss of production capacity. Multiple buildings suffered roof failures and water intrusion. Complex claim involving building restoration, equipment replacement, and extended business interruption coverage.
Significant reserve inadequacy identified requiring immediate adjustment. Strong subrogation potential against contractor for inadequate storm protection systems and building code violations. Additional recovery opportunities from equipment manufacturer warranties.
Claim Information
Financial Summary
Underwriter Portfolio View
Transform claims intelligence into better underwriting decisions and big savings
Portfolio Assessment
Portfolio audit of 6 claims across 3 coverholders reveals a 47.5% loss ratio with $89,500 in identified avoidable losses. The primary concern is reserve adequacy: 50% of audited claims show initial reserves set below final paid amounts, suggesting systematic under-reserving. Coastal Insurance Group shows the weakest claims handling. Recommend targeted reserve adequacy requirements at renewal.
3 Critical Actions Required
AI-Identified Scenarios
Commercial Property: Escalating, Complex Claim
How Claims Pulse identifies critical issues in real-time that would otherwise go unnoticed for months
The Scenario
- 🔥Fire in commercial buildingArson suspected from initial investigation
- ⚠️Potential fraud identifiedBut insufficient evidence gathered to pursue
- 📈Reserve tripled over 24 monthsSignificant cost escalation went undetected
Claim Complexity
Claims Pulse Findings
1. Potential Fraud
AI-detected fraud indicators across multiple document types that were previously missed
2. Incomplete Subrogation
Subrogation investigation incomplete, missing key recovery opportunities
3. Handler Involvement Low
Initial claims handler involvement inadequate for the size and complexity of claim
If Claims Pulse was implemented, suspicious fraud activity and subrogation would be flagged in real-time with recommended actions.
Claims Pulse Market Deployment
This case study demonstrates how Claims Pulse addresses different market needs:
TPA/DCA Monitoring
There is a big need to evaluate the performance of third parties in their management of claims, to help influence authority levels, trust and to provide a tool to help TPAs/DCAs better manage their portfolio of claims, saving significant costs
Internal Peer Review
Supercharge your internal peer reviews – rather than a small selection of audit questions with limited data collected, collect full claim information, detailed reasoning and next-best-action to nudge claim adjustors to better decision making
Lloyd's Specific
Follow LMA audit items to ensure compliance with Lloyd's market requirements and managing agent obligations
Evaluation Framework: AI + Human Expertise
The perfect balance of automation and human judgment to deliver both accuracy and continuous improvement
AI-Driven Analysis
- ✓Processes 100% of claimsEvery claim analyzed consistently, no sampling bias
- ✓55+ audit checks per claimComprehensive evaluation across all critical dimensions
- ✓Consistent, objective analysisNo variation in quality or thoroughness
- ✓Real-time flagging of issuesImmediate alerts for high-risk situations
Human Expert Triage
- ✓Focus on high-risk claimsHuman experts prioritize where judgment matters most
- ✓Validate AI findingsQuality assurance on critical decisions
- ✓Complex judgment callsNuanced situations requiring experience
- ✓Continuous model improvementExpert feedback enhances AI accuracy over time
Result: 95%+ Accuracy
AI handles scale, humans ensure precision. This hybrid approach delivers both high accuracy and continuous improvement through expert feedback loops.
Business Value: Beyond Cost Savings
Quantifiable financial impact plus strategic advantages for portfolio management and TPA oversight
Financial Impact
In avoidable losses across your portfolio
Time Efficiency
Critical for Lloyd's Market
TPAs and Delegated Coverholders (DCAs) are not well measured. Current audits are static, manual, and one-off snapshots that provide limited insight into ongoing performance.
Managing agents lack continuous visibility into delegated authority performance, making it difficult to identify issues early, benchmark quality, or influence authority levels with objective data.
From Claim File to Actionable Insight
Claims Pulse transforms unstructured claim files into structured intelligence, surfacing issues early and at scale with full traceability.
Ingest
Upload claim files in any format, any size—from FNOL to full litigation bundles
Structure
AI extracts and organizes key information, classifies documents, builds timeline
Summarize
Generate human-quality summaries and structured data extraction
Audit
Apply audit frameworks to identify issues, opportunities, and risks
Act
Receive prioritized recommendations with supporting evidence from source
Monitor
Track portfolio performance, trends, and TPA quality over time
Who Benefits from Claims Pulse
Built for the complexity of commercial insurance, tailored to the needs of Lloyd's market, global insurers, and TPAs.
Lloyd's Managing Agents
Oversee TPAs and delegated authority with confidence. Identify inconsistencies, spot leakage, and ensure claims handling meets your standards across the entire portfolio.
- ✓TPA oversight at scale
- ✓Consistent audit standards
- ✓Early leakage detection
- ✓Portfolio-wide benchmarking
Global Commercial Insurers
Manage high-volume, high-complexity claims portfolios efficiently. Surface fraud, subrogation, and reserve issues before they become costly surprises.
- ✓Scale across claim volumes
- ✓Fraud detection
- ✓Subrogation opportunities
- ✓Reserve accuracy
Third-Party Administrators
Demonstrate quality and consistency to clients. Use Claims Pulse to QA your own work and proactively identify improvement opportunities.
- ✓Quality assurance
- ✓Client transparency
- ✓Process improvement
- ✓Competitive differentiation
What Makes Claims Pulse Different
Purpose-built for commercial insurance with real audit frameworks, financial impact focus, and full traceability to source documents.
Commercial Insurance Focus
Built specifically for complex commercial lines, not generic document AI or claims summarization
Real Audit Frameworks
Based on actual claims audit methodologies used by senior claims professionals, not generic checklists
Large File Handling
Processes messy, multi-GB claim files with thousands of pages that other tools struggle with
Financial Impact Focus
Every insight tied to potential financial impact—saving, recovery, or prevention
Full Traceability
Not a black box—every recommendation backed by evidence with citations to source documents
Ecosystem Integration
Works with existing claims systems via API—policy admin, claims management, data lakes
"Outputs are indistinguishable from a human auditor—market-leading for complex claims."
— Lloyd's Managing Agent, Claims Operations Lead
Claims Pulse in Numbers
Real impact measured across commercial insurance claims portfolios
Typical Avoidable Loss Rate
in commercial claims portfolios
Accuracy Rate
on key findings vs. human auditors
Review Time Reduction
for claims audit processes
Audit Checks
per claim file across frameworks
Based on production deployments across Lloyd's syndicates, global insurers, and specialty carriers. Results validated against human claims auditor benchmarks.
Get Started with Claims Pulse
Contact us to schedule a consultation and discover how Claims Pulse can help your team identify avoidable losses and optimize claims handling.
Email Us Directly
Click below to send us an email with your consultation request. We'll respond within 24 hours.
Send Consultation RequestOr email us directly at: michael.allwright@qualrisk.com
What to Expect
- Personalized 30-minute Claims Pulse demonstration
- Review of your specific claims intelligence challenges
- Discussion of integration with your existing systems
- No pressure—just insights on how we can help
Our Process
- 1.Consultation — We discuss your claims intelligence needs
- 2.Preview — Share 10 claims, bordereau, and audit goals
- 3.Launch — See Claims Pulse in action with your data
ISO 27001 Certified
Your data is handled with enterprise-grade security and confidentiality