Document classification and extraction
Entire claim file ingested and classified. FRS canonicalization maps varied fields to a canonical schema regardless of format.
Use Cases
Insurance Claims Processing Automation
MightyBot automates insurance claims end-to-end — document classification, data extraction, policy evaluation, and state regulatory compliance. Production-grade. Audit-ready.
Why MightyBot
Insurance claims processing automation with MightyBot runs from intake to determination. Documents classified. Data extracted. Coverage evaluated against policy terms. State regulations enforced. Every decision traced to the clause, the data, and the source page. Not assisted. Finished.
Agents classify claim documents, extract facts, evaluate coverage against policy terms, enforce state-specific rules, route exceptions, and preserve an audit trail that shows which clause, source document, and evidence supported each decision.
Automate Insurance Claims Processing
A single claim file: medical records, police reports, photos, repair estimates, policy declarations, claimant correspondence — often 100+ pages in formats no two processors agree on. MightyBot classifies every document, extracts the data, evaluates coverage, and enforces state-specific regulations in minutes.
How MightyBot Executes
Policy terms evaluation
Coverage terms, exclusions, sublimits, endorsements encoded as executable logic. Same claim, same policy, same result. Deterministic.
State regulatory compliance
State-specific requirements enforced automatically. Timelines, notice obligations, fair claims practices. Updated in plain English by your compliance team.
Exception routing
High-value claims, coverage disputes, fraud indicators routed to adjusters with full context. Edge cases handled.
The Problem
Adjusters must review every document, extract facts, and cross-reference against policy language, coverage limits, deductibles, and exclusions. State-specific claims handling standards vary by jurisdiction. At volume, carriers choose between hiring more adjusters or accepting inconsistent outcomes and regulatory scrutiny. Adjusters spend 70%+ of their time gathering information — not making coverage decisions.
Document chaos
Medical records, police reports, photos, estimates, declarations from every party in different formats
Coverage complexity
Policy terms, exclusions, sublimits, endorsement interactions per claim
State regulations
Processing timelines, documentation requirements, fair claims practices vary by jurisdiction
Consistency
Two adjusters evaluating the same claim reach different conclusions
Audit exposure
Every determination must withstand regulatory examination
Before vs After
Production Metrics
70% Faster claims processing cycle time
80% Fewer manual steps per claim
99%+ Accuracy on document extraction and field mapping
4-5x More claims processed per adjuster
100% Regulatory coverage across every applicable state rule
Production-grade claims automation. Audit-ready from day one.
Use-case map
How Insurance Claims Processing Automation works in MightyBot
MightyBot automates insurance claims end-to-end: document classification, data extraction, policy evaluation, state regulatory compliance, and auditable adjudication outputs.
| Inputs | Claim files, policy declarations, medical records, police reports, repair estimates, photos, adjuster notes, and claimant correspondence. |
|---|---|
| Execution | Classifies documents, extracts loss and coverage data, evaluates policy terms, applies state-specific handling rules, and routes exceptions. |
| Outputs | Coverage determinations, exception packages, adjuster-ready summaries, compliance flags, and evidence-backed adjudication records. |
| Audit trail | Every decision traces to the policy clause, extracted value, source document, page, and timestamp. |
| Best for | Carriers and TPAs with high claim-file volume, multi-jurisdiction handling rules, and regulatory audit exposure. |
FAQ
Frequently Asked Questions
Can MightyBot handle multi-peril claims with overlapping coverage?
The Policy Engine evaluates each peril against its applicable coverage section, handles stacking and sublimit interactions, and produces a consolidated determination with evidence pointers for each component.
How does MightyBot handle state-specific claims regulations?
State requirements are encoded as policy rules in plain English. Your compliance team authors and maintains them. When regulations change, rules are updated with version-controlled tracking and enforced by jurisdiction.
What types of claim documents does MightyBot process?
PDFs, scanned images, photos, varied form layouts, medical records, police reports, repair estimates, declarations, endorsements, adjuster notes, correspondence, and damage photos. The pipeline classifies and extracts from all of them.
Does MightyBot replace our claims management system?
No. MightyBot connects to your existing claims management system via APIs. Extraction results, determinations, and audit trails flow back into your system of record.
How does MightyBot handle fraud indicators?
Fraud rules are configured alongside coverage evaluation. Claims exhibiting defined indicators - inconsistent dates, duplicates, or suspicious patterns - are flagged and routed to your SIU with full evidence trails.
What audit trail does MightyBot produce?
Every determination links to the specific policy clause, extracted data, applicable state regulation, and source pages so auditors and regulators can verify any finding without re-reviewing the entire file.