Overview
The Claims Management module is a full end-to-end workspace for processing insurance claims. It covers every stage of the claims lifecycle:- Intake — A new claim is submitted with the loss details and policy information
- Validation — The claim is reviewed to confirm it is complete and plausible
- Investigation — Participants are added, verified, and interviewed; evidence is gathered
- Decision — The claim is approved, rejected, or settled based on the investigation findings
- Audit — A complete, immutable record of every action taken on the claim is preserved
Viewing the claims list
| Column | Description |
|---|---|
| Claim Number | A unique reference number auto-generated when the claim was created |
| Policy Number | The insurance policy the claim is made against |
| Type | The line of business (Motor, Medical, Life, Property) |
| Status | The current stage in the claims workflow |
| Amount | The claimed amount in the organisation’s currency |
| Assigned To | The investigator or adjuster responsible for this claim |
| Last Updated | When the claim record was last changed |
Creating a new claim
Select the claim type
Choose the line of business from the dropdown: Motor, Medical, Life, or Property. The form fields shown will change depending on the type you select.
Enter the policy details
Fill in the Policy Number, Insured Name, and Date of Loss. The policy number is used to pull in the relevant policy terms and coverage limits from your connected policy management system.
Describe the incident
In the Incident Description field, write a brief summary of what happened. Include as much relevant detail as possible — the location, time, circumstances, and any third parties involved.
Enter the claimed amount
Enter the amount the claimant is requesting in the Claim Amount field. This can be updated later as the investigation develops.
The Motor Claim wizard
For motor insurance claims, the platform provides a structured wizard that guides you through all the required information in a logical sequence.
- Vehicle details — registration plate, make, model, year, and chassis number
- Driver details — name, licence number, and driving history
- Accident details — location, time, circumstances, fault assessment, and whether police were involved
- Damage assessment — description of damage and estimated repair cost
- Third party details — if another vehicle was involved, their details and insurance information
- Witness details — names and contact information for any witnesses
The claim detail page
- The current claim status displayed as a badge (Submitted, Under Review, Investigating, Pending Info, Approved, Rejected)
- Action buttons appropriate to the current status (e.g., Submit for Review, Approve, Reject, Request Information)
- The assigned investigator and a button to reassign
| Tab | What it contains |
|---|---|
| Overview | Claim summary, policy details, incident description, and amount |
| Participants | All people linked to this claim with their roles and KYC status |
| Documents | Uploaded evidence, attachments, and verification reports |
| Voice Analysis | Recorded interviews with participants and AI fraud analysis |
| Payments | Settlement payment details and bank verification |
| Audit | Complete history of every action taken on this claim |
Managing claim participants
Viewing participants
- Their full name and role in the claim (Claimant, Witness, Third Party, Repairer, Medical Provider)
- Their KYC status — whether their identity has been verified and when
- Their contact details (phone and email)
- Quick-action buttons to Run KYC, View Profile, or Remove them from the claim
Adding a participant
Click 'Add Participant'
On the Participants tab, click the Add Participant button in the top-right corner of the participants panel.
Search for an existing participant
Type the participant’s name, email address, or national ID number in the search box. If they have been registered in your organisation’s participant database before, their record will appear in the dropdown — click it to select them.
Create a new participant
If the participant does not appear in the search results, click Create New Participant. Fill in their full name, email, phone number, and ID number. This creates a new participant record in your database and links it to the claim simultaneously.
Assign a role
From the Role dropdown, select the participant’s relationship to this claim. Common roles include:
- Claimant — the person making the claim
- Witness — someone who witnessed the incident
- Third Party — another person involved (e.g., the driver of the other vehicle in a motor claim)
- Repairer — the garage or service provider estimating or performing repairs
The POI Profile modal
| Tab | What it shows |
|---|---|
| Identity | KYC verification status, ID details, and biometric match results |
| Voice Analysis | Recorded interviews, prosodic analysis scores, and deception indicators |
| Documents | Documents uploaded for this participant |
| Interviews | Voice interview sessions linked to this participant |
| Sanctions | Watchlist screening results |
| Risk & Network | Network graph showing connections to other claims and participants |
The audit trail
| Field | Description |
|---|---|
| Timestamp | The exact date and time the action was performed (in UTC) |
| User | The name and email of the team member who performed the action |
| Action | A plain-language description of what was done |
| Before | The state of the relevant field before the change |
| After | The state of the relevant field after the change |
- “Status changed from Submitted to Under Review by Jane Smith”
- “Participant added: John Doe (Claimant) by Mark Johnson”
- “KYC verification run on John Doe by Sarah White — Result: Verified”
- “Document uploaded: Police Abstract — by Mark Johnson”
- “Claim Amount updated from KSh 180,000 to KSh 200,000 by Jane Smith”
Claim statuses explained
| Status | What it means |
|---|---|
| Submitted | The claim has been received and is awaiting review |
| Under Review | A team member has started reviewing the claim for completeness |
| Investigating | Active investigation is underway — evidence is being gathered and participants verified |
| Pending Info | The claim is waiting for additional information from the claimant or a third party |
| Approved | The claim has been approved for settlement |
| Rejected | The claim has been declined — the reason is recorded in the audit trail |
| Settled | The approved payment has been made and the claim is closed |
Next steps
Messaging
Discuss claim details with your team through the built-in messaging system.
Identity Verification
Run KYC on claim participants to confirm their identities.