Orchestrate Complex Claims Workflows Without Replacing Your Core System
Eliminate operational friction in high-severity P&C claims. We layer governed business rule automation (IBM ODM / Red Hat Kogito) and stateful workflow orchestration over your existing Guidewire, Duck Creek, or legacy AS/400 policy ledgers — slashing cycle times and loss adjustment expenses (LAE) without multi-year core replacement risk.
Where Complex Claims Stall in Midsize & Regional P&C Carriers
While routine auto glass and simple property claims are increasingly automated via straight-through processing, complex high-severity claims remain trapped in operational silos:
1. The “Waiting Room” Problem
Claims involving bodily injury, litigation threats, or suspicious fraud patterns sit idle in general adjuster inboxes for days, driving up loss adjustment expenses (LAE) and worsening claimant churn.
2. The Multi-Million Core Replacement Trap
Core platform vendors promise built-in workflow modules, but full core replacements take 3–5 years and cost upwards of $20M+, delaying the operational relief your claims teams need today.
3. Fragmented Audit Trails & Compliance Risk
Adjusters juggle emails, external legal portal PDFs, spreadsheets, and core notes. Missing compliance deadlines (bad-faith claims litigation, statutory response windows) triggers severe financial penalties.
The Governed Claims Exception Orchestration Pipeline
How Multishoring orchestrates complex claims across core ledgers, document repositories, and human experts:
Governed Exception Orchestration for P&C Operations
Our senior automation architects resolve claims operational complexity without disrupting core ledger stability:
1. Dynamic Referral & Escalation Workflows
Stateful workflow orchestration that routes high-complexity claims based on dynamic adjuster authority limits, multi-party dispute status, and statutory timelines.
- Automatic assignment to specialist adjusters based on injury severity and jurisdiction.
- Automated SLA escalation tracking preventing missed statutory response windows.
- Real-time exception dashboard providing visibility into operational queues.
2. Business Rule Governance (IBM ODM & Drools)
Centralize underwriting guidelines, reserve authority triggers, and state compliance logic into business-readable decision tables maintained without developer intervention.
- Separation of volatile business rules from rigid core application codebases.
- Auditable rule versioning with automated simulation against historical claims.
- Instant deployment of state-specific regulatory updates across all active queues.
3. Non-Invasive Core & Document Integration
Bi-directional API connectors that bridge modern document capture tools, external legal portals, and legacy core systems (Guidewire, Duck Creek, AS/400).
- Automated extraction of demand letters and medical summaries via Document AI.
- Zero schema alterations on core insurance ledgers; 100% API and message-based.
- Bi-directional notes and reserve synchronization preserving core truth.
4. SIU Fraud, Subrogation & Litigation Milestones
Automated triage triggers that freeze settlement disbursements and dispatch Special Investigation Units (SIU) immediately upon detecting attorney representation or fraud flags.
- Automated fraud indicator scoring and instant SIU referral packet generation.
- Subrogation opportunity identification during early liability determination.
- Litigation hold enforcement ensuring compliance with defense counsel timelines.
Core Systems, Document Repositories & Engines We Unify
Our orchestration layer connects your existing claims investments into a coordinated, automated ecosystem:
- Guidewire ClaimCenter (Self-Managed & Cloud API)
- Duck Creek Claims Integration Services
- Insurity / Applied Systems Core Platforms
- AS/400 (IBM i) / RPG Custom Policy Ledgers
- Hyland OnBase & ImageRight Repositories
- Kofax / Tungsten Automation OCR Engines
- AWS Textract & Azure Form Recognizer
- ISO ClaimSearch & LexisNexis Risk Feeds
- IBM Operational Decision Manager (ODM)
- Red Hat Kogito & Drools Cloud Rules
- Camunda Platform 8 Enterprise BPMN
- Apache Kafka Claims Event Streaming
The Financial Case: Slashing Loss Adjustment Expenses (LAE)
For midsize carriers, manual friction in complex claims directly inflates operational overhead and loss payout ratios. Layered orchestration delivers rapid payback:
Why Insurance VPs & CFOs Mandate Exception Orchestration
- Curtail Runaway Defense Costs: Shaving 4–6 days off bodily injury litigation assignments reduces defense legal spend and external expert witness fees by 15–25%.
- Zero Multi-Million Core CapEx: Avoid spending $15M–$30M on a 4-year core replacement when 80% of operational friction lives in the workflow layer around the core.
- Eliminate Statutory Compliance Fines: Automated SLA monitoring prevents bad-faith litigation triggers and Department of Insurance (DOI) penalties for delayed claims correspondence.
Multi-Year Core Replacement vs. Multishoring Workflow Orchestration
Why regional and midsize P&C carriers choose modular workflow modernization over monolithic core replacement:
| Modernization Dimension | Monolithic Core System Replacement | Multishoring Workflow Orchestration Teams |
|---|---|---|
| Time to Production Value | 3 to 5 years before the first production claim is processed on the new core. | 8 to 12 weeks for production MVP automating top exception bottleneck. |
| Capital Investment & Risk | $15M–$40M+ capital outlay with high risk of operational disruption and budget overrun. | Fraction of core replacement cost; funded out of operational expense with predictable 2-week sprints. |
| Core System Disruption | Requires full historical data migration, policy conversions, and retraining of the entire staff. | 100% non-invasive; core policy and financial ledgers remain intact and authoritative. |
| Business Rule Ownership | Rules hardcoded inside vendor proprietary modules, requiring costly vendor change requests. | Empowers claims operations to modify authority limits and decision tables directly in business tools (ODM). |
| Implementation Governance | Massive systems integrator teams with extensive junior staff and rigid change orders. | Begins with a 10-day diagnostic assessment; delivered by dedicated nearshore senior engineers. |
The Core Protection & Governance Safety Protocol
Your policy administration and financial ledgers cannot be compromised. Our architecture guarantees complete stability:
Non-Invasive API Interceptors
All integrations interact through standard REST APIs, webhooks, or asynchronous Kafka events. The orchestration engine never executes direct schema modifications against production databases.
30-Day Shadow Triage Validation
New automated referral rules and complexity scoring algorithms run in parallel “shadow mode” against live claims for 30 days, validating decision accuracy before routing active adjuster workloads.
Adjuster Override & Immutable Audit
Human adjusters retain full authority to manually re-assign, escalate, or override any automated workflow decision. Every triage, decision table evaluation, and approval is captured in an audit log.
Real-World Process Automation Stories & Case Studies
Discover how transactional enterprises orchestrate mission-critical exception handling, recover leakage, and eliminate manual bottlenecks without risky core replacements.
The Interface That Went Dark: Stopping Transaction Leakage
Replaced blind-spot exception queues with a unified real-time telemetry console, resolving complex claims exceptions before compliance escalations.
Predictive Exception Triage: Averting Operational Crises
Deploying dynamic triage rules to isolate high-severity process bottlenecks and route complex exceptions 14 days before deadline breach.
90% Drop in Support Incidents at Pernod Ricard
Modernizing global document exchange from on-premise BizTalk to a robust hybrid Azure architecture with real-time exception tracking.
Start with Clarity: The 10-Day Claims Workflow Friction Assessment
A structured 10-day diagnostic sprint by senior insurance workflow architects to analyze cycle time bottlenecks in your highest-friction claims line, model business rule automation, and deliver a production-ready pilot blueprint.
Intake & Queue Audit
Analyze claims intake data, identify wait times in manual exception queues, and isolate primary cycle time drivers.
Authority & Rule Mapping
Document adjuster authority limits, supervisor escalation thresholds, and state-specific statutory compliance requirements.
Target Architecture
Design the Camunda/ODM workflow models, API integration specifications with your core system, and adjuster task list UI.
Executive Roadmap
Deliver the quantified LAE reduction business case, MVP sprint backlog, and fixed-scope delivery team proposal.
From Diagnostic Assessment to Automated Claims Operations
Following the 10-day assessment, our senior engineering teams deliver your claims orchestration through iterative, measurable sprint cycles:
Pilot Exception Workflow Sprint
Deploy the workflow and decision rule engine for one high-friction line (e.g., Commercial Auto litigation or bodily injury). Connect to core APIs and validate in shadow mode.
Production Cutover & Multi-Line Scale
Go live with automated referral routing. Expand orchestration rules to Workers’ Compensation and General Liability, automating reserve threshold checks and document indexing.
Self-Service Rule Handover & SIU Automation
Empower claims operations leads to manage ODM decision tables independently. Integrate automated fraud screening and finalize enterprise runbooks.
“Carriers don’t need a multi-million core replacement to solve operational claims bottlenecks. Our specialized engineering teams build intelligent rule-based orchestration around your existing core, delivering cycle time reductions in weeks, not years.”
Justyna
PMO Manager, Multishoring
Frequently Asked Questions: P&C Claims Exception Orchestration
Do we need to replace or modify our core claims system (Guidewire, Duck Creek, AS/400)?
No. Our architectural principle is to modernize the workflow around the core, not replace it. Your core claims platform remains the authoritative financial system of record. We integrate via standard REST APIs, webhooks, or messaging queues to trigger external review workflows and write back approved settlement decisions and notes.
Which insurance lines of business benefit most from workflow orchestration?
Our solutions deliver the highest ROI in complex, high-severity lines with multi-stakeholder reviews, including Commercial Auto (bodily injury & litigation), Workers’ Compensation (medical management & return-to-work), General Liability, and Commercial Property catastrophe claims.
How does IBM Operational Decision Manager (ODM) handle carrier authority limits?
IBM ODM provides central, business-readable decision tables that define financial thresholds, supervisory sign-offs, and state-specific compliance rules. Claims operations teams can adjust authority limits or add new triage rules in minutes through a governed interface without requiring IT code deployments.
How do you ensure AI remains governed and does not make unauthorized settlement decisions?
We strictly implement a ‘Human-in-the-Loop’ architecture. IBM watsonx AI agents assist adjusters by summarizing lengthy medical transcripts, extracting demand amounts, and highlighting policy exceptions. However, all critical actions affecting liability, reserve changes, coverage denial, and payment approvals require explicit human adjuster confirmation.
What are the primary deliverables of the 10-Day Friction Assessment?
Over 10 business days, our senior workflow architects deliver a detailed map of current handoffs and wait times for one selected claims process, an IBM BAW / ODM target reference architecture, a quantified business case based on your historical data, and a fixed-scope 8–12 week pilot roadmap.
How does your nearshore engineering team collaborate with US claims and IT operations?
Our senior automation engineers in Poland operate with 4–5 hours of daily live overlap with US Eastern and Central business hours. We run agile 2-week sprints with joint reviews, transparent Jira/Slack communication, and complete documentation for internal handoff.
Thank you for your interest in Multishoring.
We’d like to ask you a few questions to better understand your IT needs.
Signed, sealed, delivered!
Await our messenger pigeon with possible dates for the meet-up.
