Source: [Claims Operations](https://fireflysoftware.io/services/claimsos/) Description: ClaimsOS: Firefly runs the claims stages you choose, from FNOL and evidence to settlement administration. Coverage, reserves, and denials stay with your insurer. Language: en 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. [Scope your claims operation](https://fireflysoftware.io/contact/) [Request a demo](https://fireflysoftware.io/contact/?request=demo) ClaimsOS · Claims Operations, as a line of five stages. Notify: an AI model reads, classifies, extracts or drafts. Gather: an AI agent works the case within the limits you approve. Assess: our AI prepares a recommendation for your team to decide. Authorize: your team decides. Settle and close: the work is done in your systems. Unit of work · A completed claims stage [Scroll to explore](https://fireflysoftware.io/services/claimsos/#operation) 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 serves Chief 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. 01 ### FNOL and coverage check We capture the first notice of loss (FNOL) and verify the coverage facts: policy in force, trigger, and deductibles. 02 ### Triage and evidence Under your triage rules, we route each claim to fast-track or complex handling and coordinate adjusters and repair networks. 03 ### Reserve recommendations From the file and your guidelines, we recommend reserves; none is recorded as set until the insurer approves it. 04 ### Fraud indicators and SIU referral We flag fraud indicators under your rules and refer the claim to your special investigations unit (SIU). 05 ### Settlement and recoveries After authorization, we verify the payee, check for duplicate payments, and track the subrogation and salvage you pursue. 06 ### 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. 1. 01 ### Notify AI model We register the claim and verify the coverage facts. Input Reported loss and policy Output A validated notification 2. 02 ### Gather AI agent Each party gets an evidence request, and an AI agent chases it until the file is complete. Input Evidence requirements Output A structured claim file 3. 03 ### Assess AI recommends We prepare the review, recommend a reserve, and flag fraud indicators. Input File and provider reports Output A decision package 4. 04 ### Authorize Your team decides Your insurer, or the claims organization you authorize, decides; we record the instructions. Input Coverage and settlement decision Output An authorized action record 5. 05 ### Settle and close Your systems We run payment administration, communications, and final checks in your systems. Input Authorized instructions Output A completed stage or closed claim What you receive ## The finished work and the evidence behind it. Unit of work **A 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 Authority ## The decisions stay with your institution. ### You decide - Coverage determinations - Denial decisions - Reserve approval - Settlement authority - Fraud conclusions ### We do - FNOL and coverage-fact checks - Reserve recommendations - Fraud indicators and referral - Settlement administration 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. - [Customers and relationships](https://fireflysoftware.io/openplatform/modules/#customers) - [Agreements and documents](https://fireflysoftware.io/openplatform/modules/#agreements) - [Payments and cards](https://fireflysoftware.io/openplatform/modules/#payments) 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. 01 ### A focused starting point First notice and evidence for one class of claim. 02 ### How the service is priced Per claims stage or eligible claim, by line and complexity. Pricing never rewards claim denials or underpayment. 03 ### Where the service can grow Add claim stages, claim classes, recoveries, bordereaux, or ReconcileOS. Operating model ## All ten services run the same way. [See how we operate](https://fireflysoftware.io/how-we-operate/) [See service levels and control](https://fireflysoftware.io/service-levels-and-control/) 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. [Scope your claims operation](https://fireflysoftware.io/contact/) [Request a demo](https://fireflysoftware.io/contact/?request=demo)