Policy, claims and broker handoffs
Scope application integration around the records and updates needed for the selected claims or service journey.
PRAGMA EDGE / INSURANCE
Bring context to every claim handoff.
Connect claims, policy and broker systems with document workflows, physical asset operations and AI-assisted review of missing information.
01 / CONNECTOne IntegrationSystems, partners & signals02 / UNDERSTANDMaximoAssets, condition & action03 / ORCHESTRATEAI Governance
& AutomationContext, control & execution
& AutomationContext, control & execution
One connected operating story. Built around insurance.
YOUR OPERATING REALITY
Repeated document requests. Fragmented case records. Manual routing.
Insurance journeys often slow at the handoffs: a document needs interpretation, a record needs updating or a specialist needs context. Integration and bounded automation can help make those transitions more consistent.
01 / ONE INTEGRATION
Connect the claim without losing the policy context.
A claim can stall while documents, coverage records and partner responses move through different systems. Connect intake to the relevant policy and case reference so handlers can see what is still missing.
MFT & B2BApplicationsAPIsEvent streamingHybrid integration
Document-to-case intake
Explore Data Capture for document extraction and validation, with incomplete information routed to the case owner.
EVENT STREAMING / ILLUSTRATIVE USE CASE
Make the next claims handoff visible when a document arrives.
Publish document-received and case-status events to the permitted workflow consumers. Connect each update to its claim reference, with controls for duplicate notifications and restricted case information.
What to measure
Explore One Integration ↗Repeated information requests · Intake rework · Unmatched documents · Event-to-business-action latency
02 / MAXIMO
Run the insurer’s physical estate with a clear service record.
Maximo has a focused role where the insurer operates offices, facilities and maintainable equipment. Keep that scope distinct from claims adjudication while connecting asset condition to facilities work.
Inspect and monitor the estate
Organize building-equipment inspections and operating signals around asset and location records.
Coordinate facilities maintenance
Prioritize service needs, manage vendor or technician tasks and record completion for future maintenance decisions.
What to measure
Overdue facilities work · Repeat service issues · Work-order completeness
01SEE / INSURANCE
See the condition of owned facilities, workplace equipment and property operations.
Property inspection findings and facilities condition.
- Operational response
- Associate the inspection with the correct asset and location. Retain the observation and supporting evidence so the maintenance owner can distinguish a new defect from an existing condition.
- What moves forward
- A reviewable condition record linked to the affected asset.
02LISTEN / INSURANCE
Listen for changes that affect the operation.
Building-system alerts and service events.
- Operational response
- Connect the signal to its asset, timestamp and operating context. Review missing or stale readings before using a threshold breach to trigger a response.
- What moves forward
- A contextualized condition alert with an owner and a response window.
03THINK / INSURANCE
Prioritize work against the business consequence.
Maintenance risk across owned physical assets.
- Operational response
- Bring the condition finding together with criticality, existing work and service dependencies. Review the priority with claims handlers and designated decision owners before changing the maintenance plan.
- What moves forward
- A maintenance priority that reflects asset risk and operational constraints.
04ACT / INSURANCE
Connect the maintenance decision to completed work.
Traceable facilities work and field evidence.
- Operational response
- Confirm the approved scope, responsible team and required completion evidence. Return unresolved findings to the planner and use the completed record in the next review.
- What moves forward
- A closed work record, or an explicit exception with a named owner.
Example asset-management pattern · Capabilities depend on selected Maximo components and integrations.
03 / AI GOVERNANCE & AUTOMATION
Give the handler a more complete starting point.
AI can help classify claim documents and summarize missing information. Its usefulness depends on preserving evidence and review ownership, especially when the request could affect a customer’s claim outcome.
Claims packet assistance
Build a reviewable summary of received documents, unresolved questions and relevant case references.
Human-owned decisions
Keep coverage interpretation, claim approval and adverse decisions with authorized specialists. Record corrections so the assistance can be evaluated.
What to measure
Packet completeness · Handler review effort · Reopened intake tasks
A CONTROLLED PATH FROM CONTEXT TO ACTION
- 01Ground
Claim documents.
- 02Evaluate
Check access, completeness and the evidence needed for handler review.
- 03Review
Claims handlers and designated decision owners approve sensitive actions.
- 04Execute & record
Controlled case update, with the decision and its supporting evidence recorded.
THREE PILLARS / ONE EXAMPLE WORKFLOW
From an isolated event to a coordinated response.
THE INSURANCE SCENARIO
A claims packet arrives with missing evidence. Connect the policy context, flag the gap and draft a follow-up for a handler to approve.
01One Integration
Assemble the context.
Bring policy administration, claims platforms, brokers and document intake together so the event arrives with its business reference and relevant operating evidence.
Explore the integration role02Maximo
Understand the asset impact.
Relate the event to owned facilities, workplace equipment and property operations. Review condition, existing work and service dependencies before prioritizing a response.
Explore the asset response03AI Governance & Automation
Coordinate a reviewed response.
Support claims document classification and missing-information checks with approved context. Keep claims handlers and designated decision owners responsible for consequential decisions and record the outcome.
Explore governed automationOne connected workflow.Illustrative scenario. The implementation depends on your systems, asset scope and approval requirements.
Connect with Pragma Edge
Start with the challenge.
Build the connection.
Bring your business goal. Let’s shape a practical next step.