.jpeg)
TRANSFORM Solutions rebuilt the claims validation process, cut denials by 40%, and brought customers back into trust.
Anyone who has ever worked inside an insurance claims department knows how quickly things spiral when the system starts making the wrong decisions. That is exactly what happened to a well-known insurance firm in Texas. Their automation looked efficient on paper, but in reality, it denied valid claims, confused adjusters, and pushed customer frustration to an all-time high.
When TRANSFORM Solutions stepped in, the goal was simple.
Make the claims process accurate again. Bring back control. Restore trust.
By adding a Human in the Loop review where it mattered most and fixing the workflow from the ground up, the insurer saw a 40% drop in denials and a dramatic improvement in processing speed.
The insurer handles thousands of claims every month. For years, automation has helped them stay efficient. But as claim volume increased and documents became more varied, the system stopped understanding what it was looking at. The team noticed it gradually first a few odd denials, then more customer callbacks, then a sudden spike in exceptions.
Leaders could feel that something was slipping, even if the dashboards did not show it yet.
When we spoke to the adjusters, they all described the same experience.
They would open a claim and immediately think
“How did this get denied? This is obviously valid.”
A few patterns became clear
• Multi-page documents were being read incorrectly
• Low-quality photos from mobile uploads triggered automatic failures
• Claims that should have been approved were routed to rejection queues
• Missing small details, like a page number or signature, caused outright denial
• Adjusters spent hours undoing decisions the system should never have made
It was not just a technical issue. It was a daily frustration for the people doing the work.
When an insurance company starts denying claims for the wrong reasons, the consequences are immediate and painful.
Customers lose trust.
Adjusters lose productivity.
Compliance teams lose sleep.
Leadership loses visibility.
For this firm, the pressure was building
• Complaints rose
• SLA times slipped
• Backlogs grew
• Auditors began asking difficult questions
Everyone knew the workflow was broken, but no one knew how to fix it without slowing the entire business down.
Instead of replacing automation, we reshaped it into something reliable.
We introduced a Human-in-the-Loop review step that served as a safety net.
If the system was unsure or flagged something strange, a trained reviewer stepped in before a customer felt the impact.
• Claims with unclear or low confidence data were reviewed by experts
• Poor-quality documents were filtered and corrected before processing
• Routing rules were rebuilt so claims flowed to the right decision path
• A fraud and exception layer ensured questionable cases received proper attention
This combination brought balance back into the workflow.
Automation handled what it was good at.
Humans handled everything that required judgment.
Once the workflow stabilized, the improvements were unmistakable.
• 40% fewer denials
• 27% more first pass approvals
• 20% faster processing times
• Fewer compliance risks and fewer surprises during audits
• A calmer, more in control claims team
Most importantly, customers received decisions that made sense. Trust returned.
Trust TRANSFORM Solutions to be your partner in operational transformation.
Book a free consutation
Get the latest news & updates from TRANSFORM Solutions directly into your inbox
Still wondering how TRANSFORM Solutions can help grow your business?
Book a Free Consultation
.png)