On-Demand Claims Score: 3.85/5.0
On-Demand Knowledge Work | Internal audience
Subrogation identifies third-party liability opportunities , chances to recover claim payments from responsible parties or their insurers. Current process: claims adjusters manually review closed/open claims for liability signals (police reports, witness statements), manually cross-reference legal liability frameworks (state comparative negligence rules, contractual liability, insurance policy subrogation clauses), manually identify and pursue recovery actions. High caseloads (50-100+ claims per adjuster) lead to missed opportunities and lapsed statutes of limitation. Subrogation leakage: $500K-$2M+/year per mid-size insurer.
Data Sources:
Data Classification:
Data Quality Requirements:
Police report accuracy: 100% sourced from government agencies. Claim narrative completeness: 95%+ of claims have narrative descriptions. Historical recovery rate accuracy: tracked and validated against actual recovery outcomes. Legal framework accuracy: must match current state law (updated with regulatory changes).
Integration Complexity: Medium-High , Requires ClaimCenter/Majesco API integration, police report API integration (if available; may require manual upload), dashcam/photo database access, NLP for claim narrative analysis, legal framework database maintenance, historical recovery rate database (internal or sourced).
| Criterion | Weight | Score (1-5) | Weighted |
|---|---|---|---|
| Time Recaptured | 15% | 4 | 0.60 |
| Error Reduction | 10% | 5 | 0.50 |
| Cost Avoidance | 10% | 4 | 0.40 |
| Strategic Leverage | 5% | 4 | 0.20 |
| Data Availability | 15% | 4 | 0.60 |
| Process Clarity | 15% | 4 | 0.60 |
| Ease of Implementation | 10% | 3 | 0.30 |
| Fallback Available | 10% | 3 | 0.30 |
| Audience (Int/Ext) | 10% | 5 | 0.50 |
| Composite | 100% | 3.85 |
Claims data is readily available (internal). Recovery opportunities are high-value (average subrogation recovery: $5K-$50K per successful case). Automation is high-impact (most opportunities currently missed due to manual process limitations). Fallback is straightforward: adjuster manually identifies opportunities. Internal audience. Clear ROI: recover $500K-$2M+/year per insurer. Regulatory benefit: systematic subrogation process improves audit readiness and demonstrates financial control.
Sprint 0 (2 weeks) + 3 build sprints (6 weeks)
Sprint 0: Claims database schema analysis, liability signal taxonomy, legal framework mapping, recovery opportunity ranking logic, third-party contact database
Build Sprints 1-3: ClaimCenter API integration, police report ingestion, dashcam/photo database access, NLP for claim narrative analysis, liability mapping rules, recovery ranking algorithm, subrogation filing template generation, specialist escalation workflow, recovery outcome tracking and feedback loop
From zero to a governed, production agent in 6 weeks.
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