Claims Operations
Identifies the specific process steps generating repeat contacts and extended cycle times — delivered to the team that can fix them, by claim type, coverage line, and adjuster behavior.
Insurance Claims Management
Follow the claim. Hear what the record can't.
A claim moves through five stages — and at every one, the interaction carries signals the claim file never captures. Spearfish reads all of them, across 100% of your FNOL, status, and appeal conversations, and routes what it finds to the team that can act.
◆ FNOL · Status · Appeals
◆ Voice · Chat · Email
◆ 100% interaction coverage
CLAIM #48-2916 · Auto · Water Damage
In Adjusting
Lifecycle position
FNOL
Triage
Adjusting
Decision
Close
◆ Sentiment trajectoryFalling −42
◆ Repeat contact3rd call +200%
◆ Escalation riskHigh 0.87
◆ Attorney-intent phraseDetected
The Claim Lifecycle
Every stage generates a signal your claim record misses.
Trace a claim from first notice to close. At each step there's a signal hiding in the conversation — and something Spearfish surfaces the moment it happens.
☎1
Intake
First Notice of Loss
The hidden signal
Incomplete intake, an early coverage misstatement, or a policyholder who's already frustrated.
Spearfish surfaces
Intake-completeness gaps and coverage-language risk, flagged before the file moves downstream.
⇄2
Routing
Triage & Assignment
The hidden signal
Misrouting and assignment delays that quietly generate repeat "where's my adjuster?" contacts.
Spearfish surfaces
The assignment friction driving repeat contacts, routed to the ops team that owns the queue.
◈3
Investigation
Adjusting
The hidden signal
Statement inconsistencies that hint at fraud, and adjuster behaviors that lengthen cycle time.
Spearfish surfaces
SIU-relevant inconsistency patterns and the adjuster behaviors that predict resolution — or don't.
⚖4
Decision
Settle or Deny
The hidden signal
A denial explained but not understood — the seed of an appeal or a DOI complaint.
Spearfish surfaces
Denial-clarity and comprehension scores that flag the calls headed toward appeal before one is filed.
✓5
Outcome
Resolution & Appeal
The hidden signal
Attorney-intent language and a policyholder deciding, quietly, not to renew.
Spearfish surfaces
Pre-litigation and non-renewal signals, early enough for retention to still intervene.
The Problem
The signals that matter most never leave the contact center.
The claim file records what was decided. It doesn't record how the conversation went — and that's where the cost is created.
Most carriers score a small QA sample and use it to coach agents. The intelligence that should reach claims operations, SIU, and customer experience never leaves the contact center.
It stays invisible — until it surfaces as a complaint, a delayed settlement, an E&O exposure, or a policyholder who silently doesn't renew.
What stays invisible
- ⌖Process steps that extend cycle time and generate repeat contacts across the claim's life.
- ⌖Fraud & SIU signals that live in the conversation, not the claim record.
- ⌖Escalation & complaint patterns that are predictable well before a filing.
- ⌖Adjuster behaviors that actually drive resolution outcomes vs. those that don't.
Where the Intelligence Goes
Most claims intelligence stays in the contact center. Spearfish moves it to the teams who can act.
◊
Fraud & SIU
Structured claim data doesn't capture everything. Spearfish surfaces the conversational inconsistency patterns that do — across statements, contacts, and records — before payment is made.
Statement InconsistencyPre-Payment
♡
Customer Experience
Pre-complaint and pre-litigation signals are obvious in hindsight. Spearfish makes them visible early enough to act — pinpointing the status update that sent a customer looking for an attorney.
Pre-ComplaintAttorney IntentRetention
⬡
Product & Underwriting
Coverage confusion starts in how products are written and communicated. Spearfish surfaces the policy language driving preventable dispute contacts before it shows up in loss ratios.
Coverage ConfusionPolicy Language
The Result
Faster resolution. Earlier signals. Fewer repeat contacts.
Repeat contact rates fall because root causes reach the people who can fix them — not just the people managing the queue.
↑
Resolution Velocity
Cycle times shortened where the root cause was hiding in the interaction.
⚑
Earlier Fraud & SIU Signals
Surfaced before payment — not after.
↓
Escalations & Complaints
Pre-complaint signals caught while intervention is still possible.
↓
Repeat Contact Rate
Root causes fixed by the team that owns the process.
Get Started
See what your claims conversations are telling you.
A 30-minute working session with a Spearfish solutions engineer — bring a claim type, a contact channel, or a recurring escalation. We'll show you the intelligence you're missing.