The omni:us Digital Claims Adjuster

Automate your claims in
high-frequency lines of business

The omni:us Digital Claims Adjuster enables seamlessly integrated end-2-end P&C claims automation within existing insurance systems, such as Guidewire, Sapiens or legacy applications.  Integrated reference claims processes, as well as a comprehensive, AI-powered claims decision catalog, help drastically cut down process costs – while noticeably increasing customer satisfaction and efficiency.

  • Household / Property
  • Liability
  • Motor
supported perils
Fire
Storm / Elemental
Tap Water
Glass Breakage
Burglary / Theft
Automated Claims Actions for Property & Household
1

Identification and classification of

  • Policy
  • Claim number
  • Policyholder
  • Place, time
  • Risk, objects
  • Context, interpretation
2
  • Claimsfile creation
  • Prevent duplicate claims file creation
  • Amendment management

 

3
  • Contract active
  • Insignificance check (self-retention)

Coverage given for

  • Risk
  • Loss location
  • Object
  • Person(s)
4

Identification of

  • Damage
  • Extent of damage
  • Involved parties and their roles

Verification of basic completeness for

  • Mandatory information
  • Documents
  • Rel. data points

+

  • Consideration of other customer-specific completeness requirements
  • Trigger of necessary supplements
5
  • Clarification of relevant damage issues
  • Interpretation of the cause of damage
  • Clarification of obligations and exclusions

+

  • Consideration of contract-specific coverage rules
  • Triggering of necessary supplements
6
  • Determination of the amount of the claim and the amount of the payout
  • Allocation of payment information
  • Adjustment of reserves
  • Trigger of payout
Automated Claims Actions
for Household / Property
1

Claims indexation

Identification and classification of:

  • Policy
  • Claim number
  • Policyholder
  • Place, time
  • Risk, objects
  • Context, interpretation
2

Claims indexation

  • Claimsfile creation
  • Prevent duplicate claims file creation
  • Amendment management
3

Formal coverage check

  • Contract active
  • Insignificance check (self-retention)
  • Coverage given for
    Risk
  • Loss location
  • Object
  • Person(s)
4

Completeness check

Identification of:

  • Damage
  • Extent of damage
  • Involved parties and their roles

Verification of basic completeness for

  • Mandatory information
  • Documents
  • Rel. data points
  • Consideration of other customer-specific completeness requirements
  • Trigger of necessary supplements
5

Coverage Determination

  • Clarification of relevant damage issues
  • Interpretation of the cause of damage
  • Clarification of obligations and exclusions
  • Consideration of contract-specific coverage rules
  • Triggering of necessary supplements
6

Claim settlement

  • Determination of the amount of the claim and the amount of the payout
  • Allocation of payment information
  • Adjustment of reserves
  • Trigger of payout
Next Best Action OR STEERING TO CLAIMS ADJUSTER IS POSSIBLE AT ANY POINT
supported perils
Personal Liability
Home / Landowner
Automated Claims Actions for Liability
1

Identification and classification of

  • Policy
  • Claim number
  • Policyholder
  • Place, time
  • Risk, objects
  • Context, interpretation

+

  • Claimant
2
  • Claimsfile creation
  • Prevent duplicate claims file creation
  • Amendment management

+

  • Doubled claimsfile creation
3
  • Contract active
  • Insignificance check (self-retention)

Coverage given for

  • Risk
  • Loss location
  • Object
  • Person(s)
4

Identification of

  • Damage
  • Extent of damage
  • Involved parties and their roles

Verification of basic completeness for

  • Mandatory information
  • Documents
  • Rel. data points

+

  • Consideration of other customer-specific completeness requirements
  • Trigger of necessary supplements
5
  • Clarification of relevant damage issues
  • Interpretation of the cause of damage
  • Clarification of obligations and exclusions

+

  • Consideration of contract-specific coverage rules
  • Triggering of necessary supplements

+

  • Clarification of factual fault
6
  • Determination of the amount of the claim and the amount of the payout
  • Allocation of payment information
  • Adjustment of reserves
  • Trigger of payout
Automated Claims Actions
for Liablity
1

Claims indexation

Identification and classification of:

  • Policy
  • Claim number
  • Policyholder
  • Place, time
  • Risk, objects
  • Context, interpretation
  • Claimant
2

Claims indexation

  • Claimsfile creation
  • Prevent duplicate claims file creation
  • Amendment management
  • Doubled claimsfile creation
3

Formal coverage check

  • Contract active
  • Insignificance check (self-retention)
  • Coverage given for
    Risk
  • Loss location
  • Object
  • Person(s)
4

Completeness check

Identification of:

  • Damage
  • Extent of damage
  • Involved parties and their roles

Verification of basic completeness for

  • Mandatory information
  • Documents
  • Rel. data points
  • Consideration of other customer-specific completeness requirements
  • Trigger of necessary supplements
5

Coverage Determination

  • Clarification of relevant damage issues
  • Interpretation of the cause of damage
  • Clarification of obligations and exclusions
  • Consideration of contract-specific coverage rules
  • Triggering of necessary supplements
  • Clarification of factual fault
6

Claim settlement

  • Determination of the amount of the claim and the amount of the payout
  • Allocation of payment information
  • Adjustment of reserves
  • Trigger of payout
Next Best Action OR STEERING TO CLAIMS ADJUSTER IS POSSIBLE AT ANY POINT
supported perils
Fully Comprehensive Coverage
Partial Comprehensive Coverage
Glass Breakage
Vehicle Liability
Automated Claims Actions for Motor
1

Identification and classification of

  • Policy
  • Claim number
  • Policyholder
  • Place, time
  • Risk, objects
  • Context, interpretation

+

  • Car data
  • Damage to the vehicle

+

  • Claimant
2
  • Claimsfile creation
  • Prevent duplicate claims file creation
  • Amendment management

+

  • Doubled claimsfile creation
3
  • Contract active
  • Insignificance check (self-retention)

Coverage given for

  • Risk
  • Loss location
  • Object
  • Person(s)
4

Identification of

  • Damage
  • Extent of damage
  • Involved parties and their roles

Verification of basic completeness for

  • Mandatory information
  • Documents
  • Rel. data points

+

  • Consideration of other customer-specific completeness requirements
  • Trigger of necessary supplements
5
  • Clarification of relevant damage issues
  • Interpretation of the cause of damage
  • Clarification of obligations and exclusions

+

  • Consideration of contract-specific coverage rules
  • Triggering of necessary supplements

+

  • Clarification of factual fault
6
  • Determination of the amount of the claim and the amount of the payout
  • Allocation of payment information
  • Adjustment of reserves
  • Trigger of payout
Automated Claims Actions
for Motor
1

Claims indexation

Identification and classification of:

  • Policy
  • Claim number
  • Policyholder
  • Place, time
  • Risk, objects
  • Context, interpretation
  • Car data
  • Damage to the vehicle
  • Claimant
2

Claims indexation

  • Claimsfile creation
  • Prevent duplicate claims file creation
  • Amendment management
  • Doubled claimsfile creation
3

Formal coverage check

  • Contract active
  • Insignificance check (self-retention)
  • Coverage given for
    Risk
  • Loss location
  • Object
  • Person(s)
4

Completeness check

Identification of:

  • Damage
  • Extent of damage
  • Involved parties and their roles

Verification of basic completeness for

  • Mandatory information
  • Documents
  • Rel. data points
  • Consideration of other customer-specific completeness requirements
  • Trigger of necessary supplements
5

Coverage Determination

  • Clarification of relevant damage issues
  • Interpretation of the cause of damage
  • Clarification of obligations and exclusions
  • Consideration of contract-specific coverage rules
  • Triggering of necessary supplements
  • Clarification of factual fault
6

Claim settlement

  • Determination of the amount of the claim and the amount of the payout
  • Allocation of payment information
  • Adjustment of reserves
  • Trigger of payout
Next Best Action OR STEERING TO CLAIMS ADJUSTER IS POSSIBLE AT ANY POINT
Our Performance

Straight-Through Processing At Scale

%

Full Automation
Straight-through-processing

  • Focus on simple and medium-complex claims
  • End-to-end processing from FNOL to payment
  • Significant savings potential due to straight-through-processing

+

+

%

Semi-Automation
Next Best Actions & recommendations

  • Focus on medium and very complex claims
  • Significant time savings potential (up to 90%) through partial automation
  • Example processes: information requests, rejection recommendations, coverage concerns
  1. Listed KPIs are average values across different line of businesses that are calculated as a basis of value-based pricing in our collaboration with omni:us business cases.
  2. Focus on frequency claims with an average claim volume of < €3.000.

Why Omni:us?

Our mission is to enhance insurance industry processes and workflows by simplifying the claims handling life cycles. omni:us understands the value of automation by identifying key processes to shorten cycle times, enhance customer expectations, increase employee satisfaction, and improve data integrity to create better outcomes in the overall claims handling process.

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