FNOL and coverage check
We capture the first notice of loss (FNOL) and verify the coverage facts: policy in force, trigger, and deductibles.
Firefly ClaimsOS · Claims Operations
We keep each claim moving while you decide coverage and settlement.
We handle the claims stages you choose, from first notice and evidence to settlement administration once you authorize payment.
Unit of work · A completed claims stageScroll to explore
The problem
A claim waits at every handoff.
When the file, the adjuster, the reserve, and the payment sit apart, nobody sees the whole claim.
Who it servesChief claims officers, claims operations leaders, TPAs, and insurer service leaders
What the service includes
We do the work within the limits of your policy.
Your service schedule lists the tasks your operation includes.
Triage and evidence
Under your triage rules, we route each claim to fast-track or complex handling and coordinate adjusters and repair networks.
Reserve recommendations
From the file and your guidelines, we recommend reserves; none is recorded as set until the insurer approves it.
Fraud indicators and SIU referral
We flag fraud indicators under your rules and refer the claim to your special investigations unit (SIU).
Settlement and recoveries
After authorization, we verify the payee, check for duplicate payments, and track the subrogation and salvage you pursue.
Bordereaux and closure review
We produce claims bordereaux in each carrier’s format and review every file for leakage before closure.
How the service works
Five stages, and who does each one.
Each stage runs on the method that fits the cost of an error.
- 01
Notify
AI model
We register the claim and verify the coverage facts.
InputReported loss and policy
OutputA validated notification
- 02
Gather
AI agent
Each party gets an evidence request, and an AI agent chases it until the file is complete.
InputEvidence requirements
OutputA structured claim file
- 03
Assess
AI recommends
We prepare the review, recommend a reserve, and flag fraud indicators.
InputFile and provider reports
OutputA decision package
- 04
Authorize
Your team decides
Your insurer, or the claims organization you authorize, decides; we record the instructions.
InputCoverage and settlement decision
OutputAn authorized action record
- 05
Settle and close
Your systems
We run payment administration, communications, and final checks in your systems.
InputAuthorized instructions
OutputA completed stage or closed claim
What you receive
The finished work and the evidence behind it.
Unit of workA completed claims stage
- Tracked notification and evidence file
- Reserve recommendations, with the insurer’s decision on each
- Fraud-indicator and SIU referral records
- Settlement administration with duplicate-payment checks
Systems and technology
We work in your systems, on open-source modules.
Connected to your systems
Claims and policy systems, document stores, adjuster and repair networks, fraud tools, and payment and finance systems.
Built on Firefly OpenPlatform
Your teams can read the code of each module.
Measures
We measure the work you receive.
- Time to first action
- Time to complete each claims stage
- Evidence and provider wait times
- Leakage found in closure review
Scope, pricing, and growth
Start small and expand on evidence.
A focused starting point
First notice and evidence for one class of claim.
How the service is priced
Per claims stage or eligible claim, by line and complexity. Pricing never rewards claim denials or underpayment.
Where the service can grow
Add claim stages, claim classes, recoveries, bordereaux, or ReconcileOS.
Questions
What buyers ask before they scope.
Will AI deny claims?
No. Your claims team, or the claims organization you authorize, decides coverage and any denial. AI reads, sorts, and drafts, and acts only within the permissions you set.
Can Firefly handle only part of the claim?
Yes. We can take one complete stage, such as first notice and evidence collection, with clear acceptance criteria.
Who handles complex or disputed claims?
Your claims team, or the route you agree, while we keep our part of the file moving.
Your first operation
Bring us one operation.
Tell us the process, the volume, and what “done” looks like. We will come back with a scope, a deployment plan, and a proposal.