AI & Claims Intelligence

Human judgment, amplified.

Practical ways AI can help adjusters and investigators organize information, identify gaps, structure better questions, and improve workflow—without outsourcing professional judgment.

Practical Workflows

Use AI where it improves the work.

The strongest use cases reduce administrative drag or improve analytical structure while keeping the professional responsible for facts, judgment, and the final decision.

Adjuster

Claim chronology

Organize dated events, identify gaps, and surface conflicting timelines for human review.

Adjuster

Referral development

Turn a claim issue into clearer investigative objectives, questions, known facts, and information gaps.

Investigator

Interview planning

Build topic outlines, sequencing, follow-up questions, and corroboration targets before an interview.

Investigator

Research organization

Structure lawful OSINT findings, timelines, relationships, sources, and unresolved leads.

Claims / SIU

Report review

Compare the investigative objective to the reported work and identify unanswered questions or unsupported conclusions.

Leadership

Training & quality

Create scenarios, coaching frameworks, QA checklists, and consistent learning materials—with human review.

Guardrails

AI assists. The professional decides.

Claims and investigation work can involve sensitive data and consequential decisions. Responsible use requires privacy discipline, verification, governance, and clear accountability.

01Protect sensitive informationUse only approved tools and follow employer/client policy. Do not place PII, medical information, confidential claim material, credentials, or protected data into unapproved public AI systems.
02Verify every material factAI output is not evidence. Return to the underlying document, record, source, or testimony before relying on a factual statement.
03Watch for invented certaintyAI can produce plausible but incorrect information, citations, summaries, or interpretations.
04Keep humans accountableCompensability, fraud, credibility, legal, employment, and other consequential determinations remain human decisions governed by applicable law, policy, and professional judgment.
Insurance governance

NAIC Model Bulletin & regulatory work

NAIC guidance emphasizes governance, risk management, applicable insurance law, and regulator visibility into insurer use of AI-supported decisions.

NAIC Artificial Intelligence resources ↗
AI risk management

NIST AI RMF

NIST's voluntary framework is designed to help organizations govern, map, measure, and manage AI risks, including generative-AI-specific considerations.

NIST AI Risk Management Framework ↗
CFG LABS

From guidance to usable tools.

Our roadmap is focused on privacy-conscious, vendor-neutral tools that help insurance professionals structure the next step—not automate the decision.

Claims Investigation NavigatorReferral BuilderPremium Fraud Indicator MatrixAI Prompt Builder
View the Labs roadmap →
HUMAN / IN / LOOP
01INPUTUse non-PII facts and defined objectives.
02ANALYZEStructure questions, gaps, and investigative options.
03VERIFYReturn to underlying sources.
04DECIDEHuman judgment remains final.