Claims triage is the initial assessment and routing of incoming claims based on complexity, severity, fraud indicators, and required expertise to ensure appropriate handling from the start.

Effective triage is the foundation of efficient claims operations. Routing a simple claim to a senior adjuster wastes expensive expertise. Routing a complex claim to a junior adjuster creates errors, delays, and poor customer outcomes. Triage decisions made in the first minutes of a claim determine much of its eventual cost and cycle time.

Modern triage combines rules-based logic with machine learning. Rules handle the obvious: glass-only auto claims route to the glass vendor, water damage claims route to the property team. ML adds nuance: this claim looks simple but has fraud indicators; this claimant has a litigation history; this damage description suggests coverage complexity. The goal is matching claim characteristics to the right handling path.

Triage should also identify straight-through processing candidates. Claims meeting criteria for automation should bypass human adjusters entirely. The triage decision isn't just "which adjuster?" but "does this need an adjuster at all?"

Related terms: Straight-through processing rate, FNOL response time, Fraud detection