Claims — Property & Casualty

First Notice of Loss comes in via call center, agent, online portal, or mobile app. Intake reps capture loss details, run preliminary coverage checks, set initial severity indicators, and assign the claim to an adjuster based on line of business, complexity, jurisdiction, and adjuster workload/authority level.

Your SIU and experienced adjusters watch for red flags: claims filed within the policy waiting period, inconsistent narratives, known plaintiff attorneys, provider patterns, prior loss frequency, social media contradictions. Your SIU reviews maybe 5–10% of claims.

Adjusters set initial case reserves based on claim characteristics and coverage analysis, then review and revise reserves as claims develop. Supervisors conduct reserve reviews. Actuaries run bulk and IBNR analyses quarterly.

Adjusters spend 30–50% of their time reading documents: medical records, police reports, repair estimates (Xactimate, CCC, Mitchell), expert reports. They extract relevant data, summarize findings, update the file, and use the information to make decisions.

Subrogation teams identify claims with third-party recovery potential based on liability facts, third-party insurance, and claim characteristics. They prioritize pursuits by expected recovery value.