Claims Triage in Insurance: What You Need to Know for 2025

Claims triage is simply the process of quickly sorting insurance claims to decide which ones need immediate attention and which can wait.

In the world of insurance, claims triage helps companies handle many claims efficiently while making sure the most urgent problems get fixed first. Think of it like the way an emergency room works: patients with serious injuries get treated before those with minor issues.

When a claim comes in, triage decides how to categorize it based on things like the type of claim, the severity of damage, or the risk of fraud. This helps insurance adjusters focus on the cases that matter most, speeding up the claims process and improving customer satisfaction.

Here are some typical steps involved in claims triage:

• Collecting initial claim information

• Assessing claim severity or complexity

• Prioritizing claims based on risk and urgency

• Routing claims to the right department or expert

Going deeper, claims triage often uses automated tools to improve accuracy and speed. Insurance companies may use software to analyze claim details, check policy coverage, and detect inconsistencies that suggest fraud. For example, a minor fender-bender claim might be fast-tracked for quick payout, while a complicated medical injury claim undergoes deeper review.

Claims triage becomes faster and more accurate with Strada's AI-driven phone agents and automated workflows that instantly process and route claims. This technology captures essential information from customers in real time, reducing human error and speeding up claim resolution.

By integrating AI into claims triage, insurers can cut down wait times and focus human experts where they are most needed.