Claims Adjudication
Definition
The process of evaluating an insurance claim against policy terms to determine coverage and payment amount.
Overview
Claims adjudication is the decision-making process that determines whether a claim is covered and how much should be paid. Adjudication involves verifying coverage, checking deductibles, applying policy terms, and calculating payment. Automated adjudication uses rules engines and AI to handle routine claims without human intervention, reserving complex cases for adjusters. High adjudication automation rates dramatically reduce costs and cycle times.
Why It Matters
Manual adjudication is slow, inconsistent, and expensive—costing insurers $10-$30 per claim in labor alone. Inconsistent decisions across adjusters create compliance risk, customer complaints, and inaccurate reserve estimates that distort financial reporting.
How New Odyssey Helps
New Odyssey's AI adjudication engine applies policy rules consistently across every claim, auto-adjudicating routine cases in seconds while flagging complex claims with recommended actions for human reviewers.
Related Solutions & Use Cases
Claims Processing Automation
Automate insurance claims intake, validation, and routing with AI. Reduce processing time by 80% while improving accuracy.
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Enable automatic adjudication of routine claims with AI-powered decision support and compliance validation.
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