Adjusters do adjusting
Processing, indexing, and follow-ups are handled so licensed staff focus on decisions.
BPO Service
Insurance Claims Outsourcing
Direct answer
Insurance claims outsourcing delegates claims operations — first notice of loss intake, data entry, document indexing, adjudication support, and status communication — to a trained team. Actigy BPO runs the claims lifecycle to your rules with QA and audit-ready records, so adjusters focus on decisions while throughput and turnaround stay predictable.
What Actigy reports
FNOL setup timeWithin SLA
Cycle timeTracked & reduced
Document accuracyQA sampled
BacklogReported daily
How does claims outsourcing support adjusters?
Claims outsourcing handles the high-volume processing around each claim so licensed adjusters spend their time on judgment, not data entry. Actigy captures first notice of loss, sets up and validates claim records, indexes documents, requests missing information, and keeps claimants updated.
Adjudication and settlement authority stay with your adjusters. Actigy prepares claims to a decision-ready state, supports subrogation and recovery workflows, and documents every step — reducing cycle time and leakage without taking on regulated decision authority.
Capabilities included
What Actigy handles
FNOL intake
First notice of loss captured across channels and set up accurately in your system.
Claims data entry & setup
Claim records created, validated, and kept current through the lifecycle.
Document indexing
Claim documents classified, indexed, and attached to the correct claim file.
Adjudication support
Claims prepared to a decision-ready state with checklists for your adjusters.
Status communication
Claimant and broker updates handled to your scripts and service standards.
Subrogation & recovery support
Recovery opportunities identified and packaged for your recovery team.
Reporting & QA
Cycle-time, backlog, and quality reporting with sampling against your standards.
Who this is for
- Insurers, MGAs, and TPAs with high or seasonal claim volumes
- Claims teams where adjusters are stuck on administrative work
- Carriers facing catastrophe or surge-driven claim spikes
- Brokers and programs needing consistent claims administration
- Operations leaders targeting lower cycle time and leakage
Scenarios
Common situations we solve
If any of these sound familiar, outsourcing claims to Actigy is worth a conversation.
A catastrophe or season spikes claim volume.
We scale FNOL intake and processing, then return to steady-state.
Adjusters are buried in data entry and chasing documents.
We prep decision-ready files so they focus on decisions.
Cycle time and leakage are creeping up.
We standardize intake and indexing with reporting on both.
You're standing up a new program or MGA.
We provide the claims-administration engine behind it.
Is this the right fit?
When Actigy BPO is a strong fit
- You want adjusters focused on decisions, not data entry and chasing documents
- Claim volume is high, seasonal, or spikes with events
- You need consistent intake, indexing, and claimant communication
- You want measurable cycle-time and backlog reporting
- You need audit-ready claim files and QA sampling
When Actigy BPO may not be the right fit
- You need licensed adjusters to make final coverage and settlement decisions — that authority stays with you
- You are buying a claims management software platform rather than an operations team
- Your claims require on-site physical inspection that cannot be supported remotely
- You have no defined claims workflow and are unwilling to document one
Why Actigy
Why outsource insurance claims outsourcing to Actigy BPO
Predictable cycle time
Documented intake and follow-up workflows keep claims moving and backlogs visible.
Authority stays with you
Coverage and settlement decisions remain with your adjusters; Actigy prepares the file.
Leakage and SLA reporting
Cycle-time, backlog, and quality metrics reported against your service standards.
Delivery method
How Actigy launches your insurance claims outsourcing team
Every engagement follows the same pilot-first method, adapted to the controls your process requires.
- 01
Process audit
We map the current workflow, volumes, systems, exceptions, and quality bar so scope and staffing are based on evidence, not guesswork.
- 02
SOP & KPI design
We document standard operating procedures and define the KPIs and SLAs we will be measured against before anyone touches live work.
- 03
Team selection
We assemble operators and team leads matched to your domain — finance, clinical, compliance, technical — and your tooling.
- 04
Training & knowledge transfer
We run structured onboarding against your SOPs, edge cases, and systems, with sign-off before the team carries production volume.
- 05
Pilot
A controlled pilot validates quality, throughput, and turnaround against the agreed KPIs. We tune the process before scaling.
- 06
Scale
We ramp the team to full volume with capacity planning, coverage models, and the reporting cadence agreed up front.
- 07
Continuous improvement
QA sampling, root-cause reviews, and monthly business reviews keep error rates down and throughput predictable over time.
Related services and industries
Services
Industries
Resources
Visibility
What you'll see every month
Outsourcing claims processing should make quality more visible, not less. Actigy reports on the numbers that matter and reviews them with you on a fixed cadence, so the operation stays accountable. The same discipline applies whether you run lean or at enterprise Insurance scale.
- A QA sample of completed work, scored against the accuracy bar agreed at go-live
- SLA attainment — turnaround and throughput measured against your targets
- Volume, backlog, and exception trends, so capacity stays ahead of demand
- Root-cause notes on any error, with the SOP change made to prevent a repeat
- A monthly business review with your point of contact and the team lead
Engagement model
How pricing and engagement work
Actigy prices claims processing on a transparent staffing model tied to scope, volume, and complexity — the cost-to-quality ratio, not an opaque per-transaction markup. Many teams run it alongside kyc outsourcing and aml outsourcing under one delivery team, with a single point of contact.
Start with a pilot
A scoped, paid pilot proves quality and throughput before you commit to full volume.
Staffing-based pricing
You see the team, the roles, and the cost. Capacity flexes up or down with your volume.
You own the documentation
SOPs and process knowledge stay yours, which keeps switching costs low and cuts key-person risk.
Clean exit and transfer
If you wind the engagement down, Actigy returns current documentation and supports knowledge transfer.
See how Actigy would run your claims operation
Book a consultation and we'll assess scope, complexity, staffing, and delivery cost — then propose a pilot to prove quality before you scale.
FAQ
Frequently asked questions
What is insurance claims outsourcing?
Insurance claims outsourcing delegates claims processing — FNOL intake, data entry, document indexing, adjudication support, and claimant communication — to a trained team. Actigy runs the lifecycle to your rules and prepares decision-ready files, while licensed adjusters keep coverage and settlement authority.
Will Actigy make claim decisions?
No. Coverage determinations and settlement authority stay with your licensed adjusters. Actigy prepares each claim to a decision-ready state, supports the workflow around it, and documents every step, but it does not make regulated claim decisions.
Can Actigy handle catastrophe or seasonal surges?
Yes. Claims volumes that spike with events or seasons are a strong fit. Actigy scales intake and processing capacity for the surge and returns to steady-state afterward, keeping cycle time and backlogs under control.
Does Actigy support subrogation and recovery?
Yes. Actigy identifies recovery opportunities, assembles the supporting documentation, and packages files for your recovery team, helping reduce leakage without taking on settlement authority.
How is claims quality measured?
Actigy reports cycle time, backlog, and document accuracy, with QA sampling against your service standards. Issues are root-caused and workflows updated, so quality and turnaround improve over the life of the engagement.
How much does claims outsourcing cost?
Actigy prices claims processing per FTE — a transparent monthly rate per role, set by the role and your industry, not per claim or by volume. A Tech Lead owns quality; choose a managed team or staff augmentation. We work in your claims system and quote after a short process audit.
Should insurers outsource claims processing?
Outsourcing the processing around claims lets licensed adjusters focus on decisions, which is valuable when volumes are high, seasonal, or event-driven. Coverage and settlement authority stay with your adjusters; Actigy prepares decision-ready files.
Outsource the process. Keep control of the outcome.
Tell us what process you want to outsource. Actigy will assess scope, complexity, staffing model, and delivery cost.