Faster first handling
Notifications are captured on the day of receipt, completed and assigned to the right team.
Claims Assistant · Agent
Automate insurance claims handling
The Claims Assistant takes in claim notifications, checks coverage and documents and proposes settlements – the decision stays with a human.
What the Claims Assistant handles:
- Take in & check claim notifications
- Check coverage & policy conditions
- Flag fraud indicators
- Prepare settlement & recovery
- up to 66 % Automation
- 24/7 Available
- BPMN 2.0 auditable
Benefits for claims handling
How a digital worker relieves claims teams: captured faster, deadlines in view, traceably documented.
Deadlines in view
Queries, statutory interim payments and follow-ups are monitored.
Traceable files
Every check is documented with its source – for internal audit, supervisors and ombudsman schemes.
Relief during storms
In storms, hail or floods it absorbs peaks in incoming claims.
Typical claims handling tasks
From claim notification to recovery: the Claims Assistant prepares, a human decides on rejections and reductions.
Property & motor claims
- Take in notifications by portal, email, phone or broker
- Check coverage, policy status and policy conditions
- Instruct assessors, repair shops or restoration firms
- Propose reserves and adjust them when things change
- Flag fraud indicators, prepare industry database checks
- Submit payment or partial rejection for approval
Recovery & special cases
- Review closed files for recovery claims
- Prepare subrogation against liable third parties
- Report large losses to reinsurers
- Group and prioritise accumulation events
- Present goodwill requests with reasons
- Prepare complaints and ombudsman proceedings
Systems & interfaces
The Claims Assistant works with policy, claims and assessor systems – the claims system remains the system of record.
Claims & policy systems
Connection to msg.Insurance Suite, Guidewire ClaimCenter, adesso in|sure, Sapiens or SAP FS-CM via API or a BPMN 2.0 process.
BIPRO & broker links
Claims transactions via the German BIPRO standards – classic SOAP or the newer REST interfaces (RNext) – and comparable national standards.
Assessors & industry services
Handover to estimating and assessor portals such as Audatex, ControlExpert or DEKRA and preparation of industry fraud database checks.
Assistant · Agent · Worker
Three automation levels – matched to the task.
Digital Assistant
BPMN rule-based
Works strictly according to compliance and process rules (BPMN 2.0 & process engine) – perfect for structured rule sets and guided case handling, even in high-security areas.
Digital Agent
AI-powered
Understands unstructured data, emails and contracts via LLMs, takes over complex checks and decisions – autonomous tasks complementing existing systems.
Digital Worker
Autonomous AI orchestration
Solves whole processes autonomously and connects individual AI agents into teams – autonomous data transfer between legacy systems and web APIs, without media breaks.
How it works
Which organisations?
The Claims Assistant is tailored to claims handling – at insurers, at brokers and in in-house claims management.
Insurers
- Property and motor claims departments
- Claims service centres
- Recovery department
- Special investigations (SIU)
Brokers & MGAs
- Claim notification to the insurer
- Status queries via BIPRO
- Settlement under delegated authority
- Claims reporting for clients
Municipalities & fleets
- Own-damage and liability claims
- Fleet and accident claims
- Notification to the insurer
- Recovery from those responsible
Frequently asked questions
The most common questions about the Claims Assistant.
Does the Claims Assistant reject claims automatically?
No. It presents rejections and partial rejections with reasons to a claims handler, and a human always makes the decision (Art. 22 GDPR). Only decisions that grant a claim in full can be fully automated, and only where national law permits it (in Germany under § 37 BDSG).
How high is the automation level of the Claims Assistant?
Around 66 % automation is achievable for the Claims Assistant's typical tasks – coverage questions, rejections and suspected fraud deliberately stay with a human, whom the Assistant supports in a structured way.
Is the Claims Assistant a high-risk AI system under the EU AI Act?
Claims handling in property, motor and liability insurance is not listed as high-risk in Annex III. Point 5(c) classes risk assessment and pricing in life and health insurance as high-risk – the Claims Assistant is not intended for that.
Does the Claims Assistant detect insurance fraud?
It flags indicators such as inconsistencies, anomalies in documents or previous claims and prepares checks in industry databases such as Germany's HIS. Whether there is a suspicion and whether it is reported is decided by the fraud team.
Which systems does the Claims Assistant connect to?
Policy and claims systems such as Guidewire, msg or SAP FS-CM, as well as the inbox, BIPRO interfaces and assessor portals. Workflows are documented as a BPMN 2.0 process.
How is health data protected in personal injury claims?
It is processed only on a legal basis under Art. 9 GDPR, for example with consent and, where national law requires it, a release from medical confidentiality (in Germany under § 213 VVG). Access is role-based and logged.
How does the Claims Assistant fit with DORA and supervisory requirements?
It can be recorded as an ICT third-party service in risk management under DORA. National rules apply as well – in Germany, BaFin's December 2025 guidance on ICT risks in the use of AI and the outsourcing rules in MaGo.