Platform
Sprout.ai injects intelligence into claims processing & underwriting.
Why Sprout.ai?
Our purpose-built AI eliminates manual work in claims and underwriting – automating what’s routine, and empowering handlers with smart tools to quickly resolve the rest.
Robust decision support with AI-generated, data-driven recommendations & rationale, presenting case & claims handlers with insights that raise confidence in decision-making.
Exceptional accuracy enabling decisioning based on data that staff & customers trust to be right.
Data-driven decision making ensures that customer outcomes in even the most complex cases are fair, reliable & explainable.
Proven scale & agility processing millions of cases & claims annually with unlimited capacity to scale (up & down) quickly.
Rapid implementation with seamless integrations, modular design & SaaS deployment. Deploy in as little as 3 months.
How it works
Built for insurance. Trained in insurance. Trusted by insurers.
Our platform has five modules that can be used individually to address specific challenges, or combined to span your end-to-end claims and underwriting processes.
The following claims processing example shows how Sprout.ai brings complete claims lifecycle automation and intelligence to your business.
Rapidly capture & prioritize every claim. Empower teams to manage workloads more efficiently.
Our Document Processing and Coding & Enrichment modules extract, codify, and enrich data captured from unstructured documents – with exceptional speed and accuracy.
This rich, codified data fuels onward claims handling processes, including policy checking, fraud detection, and decisioning.
Instantly convert very high volumes of unstructured data with AI-OCR – from a wide variety of inbound claim documents – into clean, structured data.
This enables seamless, cost-efficient automation across the entire claims handling process.
Supplement internal records with external intelligence to build an enhanced, 360-degree view of a claim. This enables rapid, accurate validations on key claim data.
Our models enrich extracted field data with external APIs, medical databases, and web intelligence to fill gaps, cross-check accuracy, and strengthen claim insights.
Auto-adjudicate the majority of claims. Deliver actionable insights that enable claims handlers to resolve complex claims quickly, and with precision.
Our Policy Checking, Fraud Flagging, and Decisioning modules deliver fully automated, straight-through processing of claims, whenever possible.
In complex or exceptional cases requiring human intervention, these modules provide claims handlers with intelligent, actionable insights and recommendations that increase the efficiency, consistency, and accuracy of every claim.
Enable fast, accurate, and complete policy compliance checking.
Automatically interpret policy documents, extract relevant clauses, cross-reference them with enriched claim data, and validate coverage terms, exclusions, and limits.
Gain early detection of potential fraud using internal and external data sources.
Automatically generate actionable, claim-level fraud insights and risk assessments. Analyze documents for authenticity, extract key claim information, and identify anomalies and unusual patterns that could reveal bad actors at work.
Empower claims handlers with real-time, data-driven insights and recommendations – along with the rationale to explain them – via AI-assisted claim review screens.
Both staff and customers can be confident that the decision is reasoned and fair.
Sprout.ai
We handle documents in virtually any language, achieving best-in-class accuracy (even for Japanese), so we can support global insurers & multi-national operations.
Effortlessly connects to leading claims & underwriting systems, ensuring seamless integration & workflow continuity – Guidewire, Duck Creek, Majesco, Sapiens, Insurity, EIS, BriteCore, DXC & more.
All decisions are traceable, referenced and explainable to customers and regulators, providing assurance for risk, compliance & operational business leaders.
48% of policyholders don’t believe insurers have their best interests at heart. Providers who fail to invest in treating customers fairly and thoughtfully pay the price in lost revenues.
Winning new customers costs 7-9x more than keeping current policyholders happy, yet 30% of dissatisfied claimants switch, citing claims experience as a bigger reason than price.
Most popular AI in insurance use cases. Why insurers buy, not build. Our AI journey.
Does Sprout.ai have customers outside insurance?
No. Sprout.ai is 100% focused on the claims processing and underwriting needs of insurers, MGAs (Managing General Agents), and service providers, including TPAs (Third Party Administrators). Learn more
Does Sprout.ai work across all insurance lines of business?
Yes. Sprout.ai is a one-stop-shop solution that can be deployed in one line of business, e.g., Health, Life & Disability, or enterprise-wide spanning multiple product lines, e.g., Health, Life & Disability, Home & Property, Motor & Auto, Commercial, and more. Learn more
Does Sprout.ai replace existing insurance claims handling platforms?
No. Sprout.ai supports your existing insurance claims handling processes, integrating seamlessly via APIs with all claims handling and policy administration platforms. Sprout.ai is the behind-the-scenes insurance intelligence and automation platform that extracts and leverages data captured for underwriting and claims processes to cut costs, improve efficiency, enrich experience, enable growth and protect your business. Learn more
What insurance underwriting & claims management systems does Sprout.ai integrate with?
Sprout.ai seamlessly integrates via flexible APIs with all pre-existing claims management and policy administration systems, whether they are in-house builds or third-party platforms (Guidewire, Duck Creek, BriteCore, and many more), without any operational or workflow disruption.
How is AI used in insurance claims handling?
Our purpose-built AI eliminates manual work in claims and underwriting – automating what’s routine, and empowering handlers with smart tools to quickly resolve the rest. Handlers gain actionable insights (e.g., timeline of events) that guide their next best step, offer recommendations accompanied by rationale (e.g., the relevant clause in the policy), and inform final decisions. Learn more
How does Sprout.ai enrich insurance claims data?
Sprout.ai uses artificial intelligence to add context, meaning, automated policy checks, and next best steps recommendations to extracted data, producing robust, fair, and defensible claim decisions beyond simple data extraction. Data enrichment is also essential for insurers wanting to use AI to assess policy coverage and improve both leakage and fraud, waste and abuse (FWA) detection. Learn more
What operational benefits can insurers expect from Sprout.ai?
Sprout.ai clients experience instant settlement on more than 67% of claims (in seconds or minutes, not days or weeks), up to 48% reduction in operating costs, and significantly faster claim resolution. Insurers can reduce claim leakage, optimize Combined Operating Ratio (COR), enrich customer experience, and improve retention rates – both customers and staff.
Can Sprout.ai handle increased claims volumes without compromising accuracy?
Yes. Sprout.ai’s modular, scalable architecture is designed to adapt as business volumes grow, whether by product line, geography, or operational area. The platform continuously delivers exceptional levels of accuracy and performance, even as volumes rise, maintaining the same high standards for every claim processed and decision made.
Does Sprout.ai scale to accommodate unexpected surge events?
Yes. Sprout.ai’s SaaS infrastructure and insurance-trained document capture enable fast, cost-effective scaling up and down in response to unpredictable peaks, such as those caused by floods or earthquakes. The solution can quickly accommodate sudden increases in claims, preserving accuracy and compliance while delivering agility and efficiency for insurers during surge periods.
How does Sprout.ai help with fraud detection?
Sprout.ai helps insurers detect fraud using AI, predictive analytics, and other advanced checks to spot duplicate claims, document tampering, online or AI-generated images, and inconsistencies in file metadata. It can also compare claims for similarities, integrate external data, and apply rule-based or machine learning models to flag inflated costs or suspicious activity.
By automatically detecting and explaining fraudulent activity, handlers have more time to focus on genuine cases requiring further investigation.
Does Sprout.ai support multiple languages?
Yes. The platform supports automated claims data capture and enrichment in virtually any language, including complex scripts like Japanese handwriting, allowing insurers to deploy a region-specific or unified global solution, with full cross-border automation.
Which types of AI does Sprout.ai use, and how?
Sprout.ai uses a combination of different AI capabilities, depending on customer requirements. Specialized computer vision models are used for processing documents, NLP (Natural Language Processing) models for handling smaller natural language tasks, LLMs (Large Language Models) for complex text analysis and agentic reasoning, and tabular ML (Machine Learning) models, all of which can be deployed, subject to requirements.
What are LLMs (Large Language Models) used for?
Sprout.ai uses LLMs for complex text analysis and agentic reasoning. We typically deploy them in our modules for policy checking, fraud detection, and AI decisioning.
What is agentic AI and what is it used for?
Agentic AI refers to an advanced form of artificial intelligence characterized by its ability to act autonomously, make decisions, and pursue specific objectives with minimal or no human supervision. Unlike traditional AI, which often follows pre-defined rules or responds solely to commands, agentic AI systems can proactively plan, adapt, and execute multi-step tasks – even breaking down goals into sub-tasks and selecting optimal strategies for each situation.
AI is used for parts of Sprout.ai’s decision making pipeline. Agentic models can reason over context and decide the appropriate path or tool to apply to the claim or case. This helps to optimize for the key insights needed for a claim.
What are AI-generated ‘hallucinations’?
Hallucinations in insurance claims processing happen when generative AI or large language models (LLMs) produce information that is erroneous, fabricated, or not grounded in the input data or real-world facts – but may appear plausible at first glance. Hallucinations happen because LLMs generate text based on patterns and probabilities based on historical training data, without checking against real data. This can result in incorrect claims advice, misinterpretation of policy coverage, or even creation of details that do not exist within real claims records.
At Sprout.ai we validate AI-generated summarizations, recommendations and decisions with robust validation logic in order to ensure quality, trust, and explainability. This validation lens is key to make sure manual reviews happen when needed to catch any hallucinations before they have an adverse impact on the claim journey.
How does Sprout.ai ensure data security and compliance?
Sprout.ai is ISO 27001 certified and GDPR-compliant, with rigorous controls ensuring robust data privacy and retention for transparent regulatory compliance worldwide. Learn about Data Privacy & Security at Sprout.ai.
How is Sprout.ai different from other insurance claims automation providers?
Purpose-built for insurance, Sprout.ai recognizes 500+ document types. The platform combines modern technologies including advanced deep learning, AI-OCR (Optical Character Recognition), Generative AI, and LLM (Large Language Models) to accurately extract and enrich structured and unstructured data – including handwriting – with fewer training documents than our competitors, enabled by more than seven years of insurance industry-specific AI development.
