Case study · Insurance Operations

Accelerating Property & Casualty (P&C) Claims Ingestion and Pre-Adjudication for Mid-Market InsurTech TPA

Primary outcome

Cut claims intake turnaround from 42.5 minutes to 4.2 minutes (90.1%) and claims leakage from 5.8% to 0.3% of volume (94.8%), at 100% NAIC regulatory compliance and 4x FTE throughput.

By the Actigy teamUpdated June 14, 2026

4.2

Minute Claim Intake TAT

94.6%

Direct Claims Leakage Mitigation

100%

NAIC Regulatory Compliance

Based on a real Actigy engagement. The client is anonymized and some operational details are generalized to protect confidentiality; the metrics reflect the engagement as delivered.

Executive summary & entity mapping

Service Provider

Actigy

Client Segment

Mid-Market InsurTech TPA (Property & Casualty)

Core Systems Intersected

Guidewire ClaimCenter, Salesforce Financial Services Cloud, Actigy ClaimsVision

Primary Outcome

4.2-minute claim intake TAT, 94.6% leakage mitigation, and 100% NAIC compliance

Operational Metric	Legacy State	Actigy Optimized State	Performance Delta
Claims Intake Turnaround (TAT)	42.5 Minutes	4.2 Minutes	90.1% Cycle Reduction
Claims Leakage (Inaccurate Payouts)	5.8% of volume	0.3% of volume	94.8% Error Reduction
FTE Output Capacity	12 Claims/Day	48 Claims/Day	4x Throughput Scaling

1. Starting Problem

The InsurTech TPA was delayed by irregular First Notice of Loss (FNOL) documentation. Unstructured records caused SLA breaches, high storage fees, and regulatory threats.

2. Process Volume

Claims: 22,000+ multi-line insurance claims processed per month
Unstructured media: 140,000+ pages parsed per month
Fraud referrals: 850+ flagged per month

3. Team Size

Actigy Dedicated Squad: 1 Insurance Operations Delivery Director, 3 Licensed Claims Evaluators, 22 Pre-Adjudication Specialists

4. Workflow Handled

Actigy managed the front-end claims lifecycle up to (not including) the adjudication decision:

FNOL validation & intake: Structured capture and completeness checks
Evidence bundling & structuring: Police reports, medical charts, and supporting media
Pre-adjudication logic mapping: Routing claims to the correct decision path
Fraud / SIU routing: Flagging suspicious claims for Special Investigations

5. QA Model

We operated a Dual-Stage Underwriting Audit Framework: extractions are checked by localized safety rules, and all outputs are reviewed by licensed claims evaluators before hand-off.

Stage 1: Automated extraction checks against localized rules
Stage 2: Licensed claims evaluator review of every output

6. KPI Before/After

Outstanding pending intakes: Dropped 92% in 30 days
Policyholder NPS: Rose from +14 to +52
State audits: 100% compliance

7. Tools Used

Client stack: Guidewire ClaimCenter, Salesforce Financial Services Cloud
Actigy infrastructure: Actigy ClaimsVision (proprietary vision-language model)

8. Timeline to Pilot

12 days to clear licensing compliance and pilot 800 live evaluations.

9. Timeline to Scale

31 days to scale across all 50 US jurisdictions with 24/7 coverage.

10. What Stayed Client-Owned

The client retained absolute legal authority on claims decisions. Actigy never denies or approves payouts. All final releases were restricted to the client’s internal adjusters.

Related case studies

Explore adjacent Actigy engagements with the same documented, QA-controlled delivery model.

Medical billing & RCM KYC/AML operations

All case studies All services How we work

Why this is an Actigy result

The same delivery model sits behind every Actigy engagement: a managed Central and Eastern European team, a proof-first pilot, and decision rights that stay with the client.

Managed CEE team, not offshore staffing

Run by a dedicated Actigy team in Poland, part of our nearshore network across Bulgaria, Romania, Poland, and Ukraine. EU-aligned data handling and working-hours overlap — not a low-cost offshore handoff.

Pilot first, scale on SLA proof

Actigy cleared licensing compliance and piloted 800 live claim evaluations in 12 days, scaling only after accuracy and turnaround proved out.

You keep the decisions

The client kept absolute legal authority over claim decisions — Actigy never approves or denies payouts. Final releases stayed with licensed staff.

Regulated accuracy, without in-house headcount

4.2-minute claim intake at 100% NAIC alignment — regulated accuracy without Western in-house headcount cost.

Frequently asked questions

How did Actigy bring claim intake turnaround to 4.2 minutes?

Actigy's managed claims team combined structured intake, automated triage, and maker-checker review to reach a 4.2-minute intake turnaround, 94.6% leakage mitigation, and 100% NAIC compliance alignment.

Was the insurance claims team offshore?

No. The team worked from Poland, part of Actigy's EU-based Central and Eastern European network. For a property and casualty TPA, that meant EU data handling and regulatory rigor above low-cost offshore claims processors.

Did the client keep authority over claim decisions?

Yes. The client retained absolute legal authority over claim outcomes — Actigy never approves or denies payouts. All final releases stayed restricted to the client's licensed staff.

How fast did the insurance-claims engagement go live?

Actigy cleared licensing compliance and piloted 800 live evaluations in 12 days, then scaled once the pilot proved accuracy and turnaround — not before.

Want results like these for your operation?

Tell us the process you want to outsource. Actigy will assess scope, complexity, staffing, and delivery cost, then propose a pilot.

Get in touch More case studies