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Claims intake workflow assessment

Find the friction before you automate the intake

Map one claims-intake path from first notice and incoming documents through review and the claims-system handoff. Navaura identifies the decisions, exceptions, integrations, and measurement plan needed to define a responsible next step.

Built for P&C carriers and claims-focused TPAs. Your claims platform stays the system of record.

Begin with discovery to establish the workflow, objectives, and requirements that will shape the proposed engagement.

When intake work keeps spilling across systems

An intake may look simple in a process diagram and still depend on inboxes, attachments, call notes, manual checks, and unwritten exception rules. The assessment starts with the path your team actually runs.

This assessment may fit if:

  • Incoming information arrives through several channels and formats.
  • Reviewers re-enter or reconcile information before a claim can move forward.
  • Exceptions depend on individual experience rather than an explicit route.
  • Source documents and structured claim fields are hard to trace to each other.
  • A demo worked, but the integration, evaluation, or operating owner is still unclear.

Check your intake readiness

Claims Intake Quick Readiness Check v1.0 — 8 questions / 16 points. This is a directional self-check, not a scored audit or benchmark — it is separate from the printable 20-question / 40-point workflow-readiness audit.

Question 1 of 8

Is the intake path bounded to a specific channel, document set, business unit, or claims-system handoff?

A bounded assessment before a build

Navaura examines one agreed claims-intake workflow. The work is scoped around a specific intake channel, document set, business unit, or claims-system handoff rather than a broad transformation program.

  1. Current-state workflow map: entry points, handoffs, decisions, queues, exceptions, and human review.
  2. Source and system inventory: document types, approved data sources, integrations, systems of record, and ownership.
  3. Risk and dependency register: data access, privacy, security, model risk, operational failure modes, retention, and change dependencies that require owner review.
  4. Target workflow and architecture: proposed boundaries, interfaces, traceability, confidence handling, and escalation paths.
  5. Measurement plan: baseline data required, acceptance criteria, evaluation method, and monitoring responsibilities.
  6. Recommendation: proceed to a bounded pilot, resolve prerequisites first, or do not use AI for the selected workflow.

Discovery establishes the workflow boundary, access requirements, dependencies, and intended outcomes. Navaura then proposes an assessment tailored to your organization.

What this assessment does not include

  • Production software or integration delivery
  • A guarantee that AI is appropriate
  • Legal, regulatory, actuarial, coverage, or compliance advice
  • A security certification or penetration test
  • Use of production claim data before access, retention, and handling terms are approved
  • Enterprise-wide claims transformation planning unless separately scoped
  • A promised savings, staffing, accuracy, or cycle-time result

How the assessment is scoped

  1. Choose one path. Identify a single intake channel, document type, business unit, or handoff to examine.
  2. Map the real workflow. Review artifacts and speak with the people who run, own, and support the path.
  3. Define the boundary. Document interfaces, source traceability, exception handling, human review, data handling, and ownership.
  4. Make a decision. Receive a recommended next step with assumptions, acceptance criteria, and reasons to proceed or stop.

Architecture and AI in one delivery model

Claims-intake software has to fit existing data contracts, controls, queues, and support responsibilities. Navaura brings enterprise architecture, software, integration, AI evaluation, and managed operations into the same design conversation.

  • 20+ years in enterprise and insurance-system architecture.
  • Architecture, integration, application development, AI evaluation, and managed hosting are available through one accountable team.
  • Navaura designs around the existing claims platform rather than requiring a core replacement.

Questions before discovery

Is the scorecard gated?No. Visitors can complete it and see their result without submitting contact information.
How does an engagement begin?We begin with discovery to understand your workflow, objectives, systems, and constraints. We then prepare a proposal that reflects the requirements of your organization.
How does the readiness check work?The questionnaire helps identify workflow, data, and integration considerations to explore during discovery. Its result is directional and does not replace a workflow assessment.
Do we need to replace our claims platform?No. The assessment assumes the current claims platform remains the system of record unless the parties explicitly agree to examine a different architecture.
Do you need production claim data?Not to start the conversation. Navaura first confirms the workflow and data-handling requirements. Synthetic or de-identified material should be used where it can answer the assessment question. Any access to sensitive or production data requires approved terms and controls.
Does the assessment guarantee an AI pilot?No. A valid result may be to fix workflow, data, integration, or ownership prerequisites first, or to decide that AI is not appropriate for the selected path.
Can you implement the recommendation?Yes, Navaura can scope software, integration, evaluation, hosting, and support separately. The assessment does not commit either party to an implementation.

Begin with your claims intake workflow

Tell us where intake begins, where it lands, and what makes the handoff difficult. We will use that context to prepare for discovery and determine an appropriate next step.

Do not include claim, policyholder, patient, or other sensitive personal information.

orSchedule Discovery

Prefer to talk first? Bring one intake path and the systems it touches.

Let’s find out what’s actually worth building

Discuss your priorities with a senior architect. We will explore the workflow, systems, and constraints that should shape your next step.

Schedule DiscoveryCall 720-263-1262