Claims Management System
Full claims lifecycle from first notice of loss to settlement.
Claims is where a policyholder finds out what their insurer is actually like.
It’s also where cycle time, leakage, and adjuster capacity all collide in the same workflow.
Our Claims Modernization solutions help insurers:
Take the friction out of first notice of loss
Give adjusters the file assembled instead of scattered
Auto-process the claims that never needed an adjuster
Catch leakage and fraud before the payment goes out
Products + Services
Claims Modernization Solutions
What we build, implement, and support in this category.
Products
Digital FNOL Intake
Omnichannel first notice of loss, from web and mobile to phone and email.
Claims Workflow and Straight-Through Processing
Automation of the routine steps in a claim.
GenAI Document Ingestion
Extracts data from loss runs, estimates, invoices, and claim correspondence.
AI Copilots
Assistants built into the workflow an adjuster already uses.
Subrogation and Litigation Management
Recovery and legal workflow tracking.
Vendor Payment Reconciliation
Matches and reconciles payments to repairers, medical providers, and other claims vendors.
Services
Claims Transformation Consulting
Optimizing claims operations, workflow, and automation.
Use Cases
Where Insurers Put Us To Work
These are places we do real work in a claims operation. Each one has been built for an insurer already, and most engagements start in one and expand from there.
First notice of loss
Taking a loss report through whatever channel the policyholder chooses, capturing what is needed without an interrogation, and opening the claim with the file already populated rather than waiting on someone to key it.
Adjuster workflow and decision support
A single view holding the policy, the loss history, the documents, the vendor activity, and the reserve position, with summarization where it saves reading time. The measure is whether an adjuster can pick up a file cold and know where it stands.
Straight-through processing for routine claims
Auto-adjudication for low-complexity, low-value claims that never needed a person, with a defined referral path back to an adjuster for the ones that do. This is where cycle time moves most, and it is also where the governance has to be tightest.
Fraud detection and claim validation
Validating what a claimant submitted against what can be independently observed: image analysis, geolocation, timestamps, weather data, claimant history. Confidence scoring and anomaly flagging that support an adjuster’s judgment rather than overriding it.
Claims payments and vendor reconciliation
Matching and reconciling payments to repairers, medical providers, and other vendors, tracking outstanding and stale payments, and applying the compliance rules around unclaimed property.
who we serve
Solutions often look different depending on where you sit
Carriers
Volume, line variation, and a claims system that makes every workflow change a project. Cycle time and leakage are board-level numbers, and both live in this process.
Paktolus for Carriers →MGAs
Claims handling is a condition of your capacity, not an afterthought. What matters most is data flowing back to your carrier partners in the form they expect, on the schedule they expect it.
Paktolus for MGAs →Mutuals
Every claim is a member you will see again. Speed matters, but visible fairness matters more, which shapes what should be automated and what should not.
Paktolus for Mutuals →Agencies and Brokerages
You advocate on claims rather than adjudicate them. The gain is in status visibility and carrier connectivity, so your account teams can answer a client without three phone calls.
Paktolus for Agencies + Brokerages →Wholesalers
Claims coordination falls to you on binding authority business, usually without the systems to see what is happening.
Paktolus for Wholesalers →Reinsurers
Loss notification and recovery data arriving from cedents and third-party administrators, often later than you would like and rarely in a consistent shape.
Paktolus for Reinsurers →Results
How would results like these impact your business?
AI-powered claims processing for a home insurer
Property damage assessment was manual, subjective, and exposed to fraud during high-volume storm and flood events. Adjusters were working from photographs with no way to verify the images were genuine. We implemented computer vision analysis of pre and post FNOL property images, enriched with geolocation, policy data, claimant history, and weather feeds, producing a confidence score and an annotated report for the adjuster rather than a decision that replaced them.
50%
Faster claim processing
25%
Improvement in adjuster productivity
20%
Decrease in fraudulent or exaggerated payout
15-point
Increase in customer satisfaction
Enterprise claims transformation for a specialty carrier
A specialty insurance and reinsurance carrier had already run an internal diagnostic across FNOL, claim setup, assignment, processing, and reporting. What it needed was a partner to validate the findings and turn them into something executable. We redesigned the claims lifecycle end to end: standardized FNOL intake, optimized routing and workload balancing, administrative tasks offloaded from adjusters to a structured support model, a unified reporting framework, and a hybrid onshore and offshore operating model.
30%
Reduction in early stage claims leakage
33%
Reduction in rework
35%
Reduction in adjuster administrative workload
27%
Improvement in overall claim cycle time
Automating payment reconciliation and unclaimed property
A financial operations team was reconciling a high volume of issued payments across multiple systems and bank accounts by hand, while tracking escheatment obligations manually. We built a unified reconciliation and compliance platform that pulls payment data across systems, matches issued against cleared in real time, flags mismatches, and applies state-specific unclaimed property rules with full audit tracking.
95%
Reduction in manual reconciliation time
90%
Match rate between issued and cleared payments
80%
Faster identification of unmatched or stale payments
Our approach
The question we always start with is:
“What does done actually look like for you?”
Some clients come to us with a defined project. Others come with a problem and no idea what the shape of the solution is. Either way, the answer to that question is what we build against. We plug in wherever you need us, from a single initiative to a full-scale program, and we stay as long as it’s useful.
CEO and Co-Founder
From consulting to execution.
Advise
Discovery, process assessment, build-versus-buy analysis, and scoping. Some engagements stop here, and that's a legitimate outcome. You leave with a decision you can defend and a plan someone can actually execute.
Deliver
Custom development or implementation and configuration of what you already run. Phased, specified, and measured against the outcome you chose. When it goes live, your team knows how to run it.
Support
Ongoing support, enhancement, and managed services, for what we built or for what you were running before we met.
We’re technology and vendor agnostic. Sometimes the right answer is custom-built around exactly how your team works. Sometimes it’s optimizing the platform you already run on. We don’t lead with a preferred stack, we lead with your goals.
Common Questions
Questions Insurers Ask Us About Claims Technology
Yes, and the size of your IT team is usually the reason the work is worth doing rather than a reason it isn’t. We scope projects to be run and maintained by the team you actually have, not the team a vendor wishes you had. That means fewer moving parts, documentation your staff can use, and a handoff that assumes nobody has spare capacity to babysit a system. If a project would leave you dependent on us to keep the lights on, we’d rather design it differently.
No, and the engagements that work are careful about this. Straight-through processing is for low-complexity claims that never needed a person, and every implementation has a defined referral path back to an adjuster. Everywhere else, the tooling gives an adjuster better inputs with the reasoning visible so they can check it. On a recent build the AI produced a confidence score and an annotated report; the adjuster still made the call.
Often not. A great deal of what insurers want from a new claims platform can be delivered around the one they have: intake, document handling, workflow tooling, payment reconciliation, and the reporting layer. When replacement genuinely is the right call we implement and integrate claims platforms too. What we won’t do is tell you the answer before we understand how your operation actually runs.
We work across the tooling our clients already run rather than a preferred stack. On claims engagements that commonly includes Guidewire ClaimCenter and Duck Creek Claims, estimating and imagery platforms, fraud and analytics tools, and the payment and document systems around them. That is a sample rather than a list of preferences. We are not a reseller, so the right tooling is whatever fits the operation you already have.
The pilot line of business works and the rollout stalls. Reserving practice, authority levels, and vendor relationships differ enough between lines that a workflow built for one rarely survives contact with the next. We scope the second line while building the first, so the pattern that gets built is one that can actually extend.
Tell us your biggest pain point.
We'll tell you how we've solved for it.
Twenty minutes, a candid conversation. If we’re not the right fit, we’ll say so.