Every module built for one purpose: faster, more accurate claims triage.
ClaimVyne is not a general-purpose AI platform. It's a purpose-built claims triage engine — designed around the workflows, data formats, and decision logic that P&C carriers actually use.
FNOL Ingestion — Any Format, Any Channel
FNOL reports arrive in as many formats as the carriers who file them. ClaimVyne reads them all — without manual data entry on your team's end.
- Carrier portal form submissions
- Inbound email FNOL (structured + free text)
- EDI 278 / 837 electronic intake
- Fax-to-text via OCR pipeline
- Third-party administrator (TPA) data feeds
- ISO ClaimSearch integration
Coverage Matching — Real-Time Against Your PAS
ClaimVyne connects directly to your policy administration system and runs the FNOL data against active policy records in real time. No manual lookup. No stale exported data.
- Real-time PAS query — confirmed active policy at time of loss
- Coverage confirmation with applicable limits and deductibles
- Exclusion checking — flags potential coverage disputes
- Confidence scoring — routes ambiguous matches for human review
- Multi-policy matching (umbrella, endorsements)
Adjuster Routing — Skill-Matched, Context-Rich
ClaimVyne doesn't just route to the next available adjuster. It routes to the right adjuster — with the complete claim context already loaded in their queue.
- LOB, geography, and complexity-based matching
- Real-time queue load balancing across your adjuster team
- Pre-populated adjuster dossier — FNOL + coverage summary + liability estimate
- SLA tracking built into every assignment
- Supervisor override workflow for contested routing decisions
Liability Estimation — Initial Reserve Baseline at Intake
ClaimVyne generates a preliminary severity score and reserve baseline when the FNOL is processed — before the adjuster opens the file. This is not a final reserve. It's a structured starting point that reduces the time adjusters spend establishing an initial reserve from scratch.
- Severity score (1–10) calibrated by LOB and loss type
- Preliminary reserve estimate from historical claim benchmarks
- SIU referral flag based on configurable rule triggers
- Subrogation potential indicator
- Adjusters always have override authority — this is a baseline, not a decision
All four modules work as a unified pipeline.
ClaimVyne is deployed as a single integrated layer between your FNOL intake channels and your claims management system.
Ingest
Any FNOL format, any channel
Match
Real-time PAS coverage query
Estimate
Severity scoring + reserve baseline
Route
Skill-matched adjuster assignment
ClaimVyne is a triage layer. Here is what it does not do.
Precision in scope matters for claims automation. Overpromising on automation boundaries creates liability exposure and erodes trust with claims leadership. These lines are intentional.
ClaimVyne does not replace adjusters
ClaimVyne routes claims to adjusters and pre-populates their files. It does not adjudicate coverage, settle claims, or substitute for licensed adjuster judgment. Every claim enters an adjuster's queue with human decision-making authority intact.
ClaimVyne does not make coverage decisions
Coverage matching returns a confidence score and confirmed policy data — it does not issue a coverage determination. Ambiguous matches are flagged for supervisor review before any routing occurs. Coverage acceptance or denial remains a carrier decision.
ClaimVyne does not replace your CMS
ClaimVyne is a triage layer deployed between your FNOL intake channels and your claims management system — Guidewire ClaimCenter, Duck Creek, Majesco, or a proprietary platform. It enriches and routes claims into your existing system of record. No rip-and-replace, no parallel claims database.
Request a pilot with your own FNOL sample.
We run pilots against your actual claim types — not synthetic data. Carriers typically see their first routing results within 4 weeks of integration kickoff.