Clive™ - the insurance industry's first AI Claims Adjuster. Qorus-NTT DATA Innovation in Insurance Awards 2025

Claims management is at the core of the insurance experience, yet it remains burdened by inefficiencies, outdated processes, and legacy technology. Adjusters, the backbone of claims handling, spend the majority of their time on administrative work rather than decision-making and customer service. To address these challenges, and based on the success of its AI-native claims management platform, Five Sigma developed Clive—the industry’s first AI Claims Adjuster. Clive can:

-Automate routine tasks such as claims triage, data entry, communication, and compliance tracking. Enhance adjuster decision-making by providing data-based recommendations for reserves, vendor selection, and next best actions. -Optimize claims progression by dynamically advancing claims according to the insurer’s Standard Operating Procedures (SOPs). -Improve operational efficiency by automating claims workflows, enabling faster resolution. -Ensure data-based claims routing by assigning claims based on adjusters’ expertise, workload, and claim complexity. -Retrieve needed information from any claim documents in seconds, saving valuable time. -Provide real-time insights by analyzing claims data and surfacing key performance indicators to claims managers. -Ensure compliance with clear and explainable audit trails.

By deploying Clive, insurers can increase claims processing speed, reduce costs, and enhance customer satisfaction—without replacing their existing claims management system.

Reasons Behind the Innovation The traditional insurance claims process has not evolved fast enough to meet the expectations of modern policyholders or the efficiency demands of insurers. The main drivers behind Clive’s development include:

-Automation is the Future – Insurers operate in a market where efficiency directly impacts profitability. Many claims systems lack automation capabilities, leading to high operating costs and slow processing times. Clive introduces automation-first claims handling, significantly reducing manual work.

-Insurance Talent Shortage – The insurance industry is facing a claims adjuster shortage, with experienced professionals retiring and fewer young professionals entering the field. Clive bridges this gap by providing AI-driven assistance that reduces cognitive load, accelerates training, increases adjuster productivity and reduces burnout.

-Customer Expectations Have Shifted – Policyholders now expect fast, digital, and seamless claims experiences, yet many insurers still operate with paper-heavy processes and outdated technology. Clive ensures faster and more accurate claim resolution by automating all stages of the claim process.

State of Competition The market offers several AI-powered point solutions that automate specific aspects of claims handling, such as fraud detection, document processing, or chatbots for policyholder interactions. However, these solutions lack the comprehensive capabilities needed to fully handle and advance a claim from start to finish.

Clive is the industry’s first and one of a kind AI Claims Adjuster, that provides true end-to-end claims handling. Unlike AI tools that assist with isolated tasks, Clive operates with the know-how of a seasoned adjuster, leveraging extensive insurance and claims expertise to drive data-based, automated, and compliant claims processing.

Departments Involved -Product & Engineering – Developed the AI algorithms, workflow automation, and integration capabilities. -Claims Experts & Industry Professionals – Provided real-world insights to shape Clive’s capabilities to ensure usability and -compliance with insurance regulations. -Marketing & Business Development – Drove awareness and adoption among insurance providers. -Customer Success & Implementation Teams – Managed deployments, onboardings, and customer support.

Clive’s development was a cross-functional effort, ensuring a balance between technical innovation and real-world claims handling expertise.

Main results Based on data gathered among current Clive customers, we’ve seen measurable improvements across multiple key performance indicators:

Saves 10–20 Hours Per Claim – Clive automates manual tasks such as data entry, document processing, and communication tracking, allowing adjusters to focus on high-value decisions instead of administrative work.

20–35% Faster Claims Cycle Time – By orchestrating claims progression automatically, Clive ensures that claims move forward without unnecessary delays, from FNOL to settlement, reducing wait times for policyholders.

20–35% Claims Cost Reduction – Clive minimizes inefficiencies by accurate reserve management, optimizing resource allocation, and cutting down on redundant processes that inflate claims costs.

15–30% Lower LAE (Loss Adjustment Expense) – By handling repetitive administrative work, automating compliance checks, Clive reduces the need for excessive adjuster intervention, lowering operational expenses.

50–70% Human Error Reduction – Clive eliminates common adjuster mistakes by validating claim details, cross-referencing policy data, flagging inconsistencies before they lead to incorrect decisions, and providing data-based recommendations to ensure accurate handling.

3–10% Indemnity Cost Reduction – Clive enhances reserve accuracy by analyzing claim data in real-time, ensuring that indemnity payouts are aligned with policy terms and industry benchmarks.

5–10% Claims Leakage Reduction – Clive detects potential overpayments, duplicate payments, and suspicious activity early in the process, ensuring claims leakage is kept to a minimum.

40–50% QA and Compliance Savings – By automatically logging all claim actions, communications, and document updates, Clive simplifies audits, reducing the time and cost required for quality assurance.

10–20% Revenue Growth – Insurers using Clive can handle higher claim volumes with the same workforce, enabling them to scale efficiently and improve their financial performance.