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Give claims teams connected context for the next decision.
ARIA Claims is for claims operations. It prepares first-notice intake, checks coverage against the policy in force on the date of loss, and drafts reserve guidance and assignment recommendations. Each one goes to the adjuster or supervisor with authority to decide. Your claims system still creates the claim, posts reserves, and issues payments.
Claims workflows in the current product build
In current product build| Workflow | What ARIA prepares | Boundary |
|---|---|---|
| First notice and completeness | A draft first-notice record matched to the policy, plus a list of missing required facts. | The claims system assigns the claim number after human review. A policy below the match threshold is never picked silently. |
| Coverage on the date of loss | A coverage chart built from the policy as it stood on the date of loss, citing your form language, with open questions listed. | An unresolved exclusion leads to investigation or a draft reservation-of-rights letter, not a denial. A denial can only be a draft for a licensed adjuster. |
| Reserve guidance | A reserve range drawn from your reserve playbook, historical data, or worksheet, labeled as guidance and not an actuarial opinion. | Without those sources, guidance is withheld rather than estimated. Amounts above the reviewer's authority route upward, and the claims system posts the reserve. |
| Assignment | A recommended handler (examiner, independent adjuster, or other desk) based on licensing and workload. | A person assigns in the claims system. |
| Signals and drafts | SIU signals, subrogation opportunities, correspondence drafts, settlement memos, and close checklists. | An SIU signal is not a fraud finding. Letters are signed and sent by the carrier. ARIA never closes, denies, or pays a claim. |
Human-in-the-loop review applies to every material claims decision. On this site it appears as adjuster review or supervisor approval.
Worked example: a reserve above examiner authority
Illustrative example on synthetic data
Coverage review → reserve approvalBlocked · high severity
- Claim
- California auto bodily-injury claim with injury reported and high severity. Loss date Jun 18, 2026, on the synthetic Pacific Coast Transport policy.
- Step 1: coverage
- A licensed examiner confirms coverage against the policy as in force on the date of loss, or asks for more facts
- Recommendation
- Reserve guidance range of $70,000–$95,000, drawn from the carrier's reserve playbook and labeled guidance, not an actuarial opinion
- Authority check
- The examiner's authority is $25,000, so the item is blocked until coverage review is complete and then routed to the claims supervisor
- Human decision
- Claims supervisor accepts, edits, or rejects, with a reason recorded for any edit or rejection
- Resulting action
- The claims system posts the reserve the supervisor approves.
- Evidence
- Coverage chart with citations, guidance sources, authority routing, the supervisor's decision, and timestamps
When the answer is no, or the clock runs out
- An SIU referral with no fraud indicators is shown as closed, and the signal does not delay payment.
- When an assignment misses its service level, it becomes visible to the claims supervisor for reassignment, and the reason is recorded.
- A rejected recommendation goes back with the reviewer's reason. Nothing reaches the claims system without approval.
Pilot measures
Example pilot measures
| Measure | Definition | Baseline source | Quality guardrail |
|---|---|---|---|
| Time to coverage position | First notice to documented coverage position | Claims system timestamps | Reservation-of-rights and reopen rates |
| Reserve review cycle | Guidance prepared to approved reserve | Claims system timestamps | Size and count of reserve changes after first review |
| Escalations and service levels | Items routed above examiner authority, and missed service levels | Work queue history | Supervisor override reasons reviewed |
Measures are set from your own baseline before a pilot starts.
Current status
The claims workflows above are in the current product build. Integration with your claims system is scoped during the engagement.
Product availability and assurance status →KGA ARIA™ by KGAgentic
Insurance workflow orchestration beside your core systems · Policy → Billing → Claims
About · Availability & assurance · Privacy · Contact
KGA ARIA™: Canadian trademark application filed, pending.
© 2026 KGAgentic. KGAgentic is the operating name of Krishcon Guide Agentic Solutions Inc., Cambridge, Ontario.
Insurance workflow orchestration beside your core systems · Policy → Billing → Claims
About · Availability & assurance · Privacy · Contact
KGA ARIA™: Canadian trademark application filed, pending.
© 2026 KGAgentic. KGAgentic is the operating name of Krishcon Guide Agentic Solutions Inc., Cambridge, Ontario.