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InsuranceInsurance operations

Prepare suspicious-claim evidence for specialist review

Investigation teams assemble transactions, documents, and prior-case context manually. Inconsistent evidence can make it difficult to examine a referral fairly.

Explore the ROI scenario

Solution blueprint: implementation is scoped with your team. The workflow below describes an engagement approach; it is not evidence of a completed customer deployment or a guaranteed return.

FROM PROBLEM TO PROCESS

How the workflow can improve.

  1. Collect permitted signals and source records.

  2. Prepare a factual timeline and identify conflicting information.

  3. Route the evidence to a specialist for investigation and disposition.

How Genellipse brings the platforms together.

Genellipse maps the business rules and source systems, configures the agreed capabilities, and validates the workflow with the people who will operate it. Existing systems and supported interfaces determine the integration approach.

AegisNow

Insurance, reinsurance, and actuarial operating context: connect policy, claims, financial, and modeling workflows within the agreed implementation scope.

GeneData

Data foundation: connect approved sources, prepare governed datasets, track lineage and quality, and support repeatable analysis and reporting.

Cortex AI

Agent workflow: assemble evidence, assist with drafting and coordination, and apply configured permissions, evaluation, approval, and monitoring controls.

VALUE TO MEASURE

Where ROI can come from.

Reduce evidence assembly effort and repeated searches. Measure referral quality and false positives rather than count flagged claims as savings.

Track these measures against your baseline.

  • Preparation hours per referral
  • Referrals returned for missing evidence
  • Specialist-assessed false-positive rate

Agree definitions, data sources, and an observation period before the MVP. Compare similar work, include exception handling and quality review, and subtract implementation and ongoing operating costs.

Start with a focused, reviewable MVP.

Suggested starting scope
A retrospective referral sample assessed by experienced investigators.
Data and integration needs
Claim history, permitted signals, referral reasons, and investigation procedures.
Review and control requirements
Specialists decide investigation and claim outcomes; no automatic fraud accusation or denial.

What Genellipse can deliver with your team.

A current-state workflow map, data and interface assessment, configured MVP, evaluation evidence, and a phased delivery recommendation. Agree the output, acceptance criteria, operating owner, and improvement measures before extending the scope.

BUILD YOUR BUSINESS CASE

Explore an illustrative ROI scenario.

Replace these example assumptions with your own baseline and validated MVP results. This calculator estimates the value of processing-time improvements; it does not predict a customer outcome.

ILLUSTRATIVE FIRST YEAR

Capacity hours released annually
2,000
Annual realized capacity value
CA$60,000
First-year total cost
CA$44,000
First-year net value
CA$16,000
First-year value ROI
36.4%
Simple payback
6.7 months

Released capacity becomes cash savings only when spending is actually avoided. Otherwise, measure the value of agreed redeployment or additional output. The realization percentage must reflect that distinction.

Calculation method and assumptions

Annual hours = monthly volume × minutes saved per item × 12 ÷ 60. Annual realized value = annual hours × hourly cost × realization percentage. First-year cost = implementation cost + 12 × monthly operating cost.

First-year value ROI = (annual realized value − first-year cost) ÷ first-year cost. Payback = implementation cost ÷ monthly value after recurring costs, when that monthly value is positive.

The example assumes steady volume and immediate full operation. Include integration, licensing, AI usage, infrastructure, support, quality review, training, and change management in your costs. Model ramp-up separately before an investment decision. Currency selection changes the unit label; it does not convert amounts. Do not add the same benefit again as headcount savings, revenue, or avoided rework.

Include this scenario in an enquiry

The assumptions are added to an editable message. They are sent only when you submit the enquiry.

Bring us the workflow you want to improve.

Tell us about your source systems, current bottleneck, and the outcome you want to measure. Your selected use case will be added to an editable enquiry so we can start with the right context.

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