Duplicates
The same loss, claimed twice
The same invoice, photo or receipt turns up on claims with different insurers or under a different policy. Adjusters rarely see both.
Threat squad
Clara Adjusta — Senior AI Claims Intelligence Officer
AI claims analysis your SIU can act on
Clara Adjusta — Senior AI Claims Intelligence OfficerClara Adjusta is an AI agent that triages insurance claims as they arrive. She checks each claim against the policy and the claimant's history, flags duplicate, staged and inflated claims and prepares SIU referrals with the evidence attached. Your adjusters and investigators make every decision on the claim.
Clara Adjusta
Motor claim #CL-90214 triaged
IllustrativeFlagged for SIU review
Fraud indicators 4 · high
Flag explained
“Same repairer and photos seen on an earlier claim. Policy started shortly before the loss.”
Job description
What Clara Adjusta does Job description
Clara Adjusta is a Senior AI Claims Intelligence Officer. She sits beside your claims system, triages each claim as it arrives and prepares the evidence your adjusters and SIU need.
AI AGENT · THREAT SQUAD
CLARA ADJUSTA
Senior AI Claims Intelligence Officer
REPORTS TO
Your Head of Claims or SIU lead
WORKS WITH
Your policy administration, claims, document management and payment systems
DEPLOYED
Shadow mode first, then the autonomy you set
KEY RESPONSIBILITIES
01Triage claims at intake against policy terms, cover dates and the claimant's history
02Flag duplicate, staged and inflated claims, with the links and documents that raised the flag
03Match images, invoices and parties across current and past claims
04Prepare SIU referrals with the policy history, prior claims and evidence attached
05Mark clean, low-risk claims for your fast-track process with a recorded reason, only where you allow it
AUTONOMY MODEL
LOWMEDIUMHIGH
Low risk
Can mark clean claims for fast-track, if you allow it
Medium risk
Goes to an adjuster by default
High risk
Always goes to an adjuster or the SIU
You set the threshold per rule.
Kill switch: Turn Clara off at any time
Options
How the options compare
| CRITERIA | Adjuster review | Claims rules engine | Clara Adjusta |
|---|---|---|---|
| Time to first results | A hiring and training cycle | Rule build per claim line | Shadow mode on your live and closed claims |
| Who decides | Adjuster | Rule threshold, then adjuster | Adjuster and SIU, inside autonomy bands you set |
| Links across claims | Only what the adjuster remembers | Exact matches on set fields | Documents, images and parties matched across claims |
| Why a claim was flagged | Adjuster notes | Rule ID | Plain-English reason with the links behind it |
| SIU referral | Written by hand | Flag only | Referral prepared with evidence attached |
| Where it's weaker | Slow and inconsistent at volume | Misses patterns nobody wrote a rule for | Needs claims history and SIU outcomes to calibrate; new product lines start with less to compare against |
Works best with
AI agents that work best with Clara Adjusta
Clara's referrals get stronger when other agents add outside evidence and a clean record.
THREAT
Oscar Gray
Senior AI OSINT Intelligence Director
Adds public records and adverse media on claimants, repairers and clinics.
Meet OscarTHREAT
Aiden Flux
Senior AI Fraud Risk Analyst
Scores claim payments and premium flows for unusual patterns.
Meet AidenRISK AND GOVERNANCE
Arin Narrate
Senior AI Audit Trail Specialist
Links every triage and referral to its evidence for audit and regulator review.
Meet Arin
Thoughts that matter
Insights on AI agents, financial crime and compliance
What we're learning about AML, fraud and the evidence examiners ask for.
Best AML Software in 2026: An Honest Comparison for Banks and Fintechs
Read More
goAML Registration and STR Filing in the UAE: A Step-by-Step Guide for Reporting Entities
Read More
Transaction Monitoring Software: UAE Acceptance Checklist
Read More
PEP and Sanctions Screening: What the MLRO Owns
Read More
Session Risk Scoring: Continuous Authentication for Banks
Read More
Impossible Travel Detection in Banking: How It Works
Read More
Questions? We Have Answers
-1.svg)
Frequently Asked Questions
Still have questions?
Talk to the people who build the agents. We'll answer per capability, yes or no.
An AI agent checks each claim against policy terms and the claimant's history, then matches documents, images and parties against earlier claims. Clara Adjusta flags duplicates, staged and inflated claims with the links behind each flag and prepares SIU referrals. Your adjusters and investigators decide.
No. Clara triages and flags. Payment and denial decisions stay with your claims team. She can mark clean, low-risk claims for your fast-track process only where you allow it, with a recorded reason. A kill switch turns Clara off without touching your claims system.
Clara works on the claim data you provide, such as motor, property, travel or health. We agree the claim lines and fraud indicators with your team during deployment design.
Most claims are genuine, and Clara's job is to move them along and pick out the few that need a closer look. Every flag carries a reason, so an adjuster can clear a genuine claim quickly.
Claim details, policy data, documents and images from your claims system, plus past claims and SIU outcomes. Outcomes help her learn what your team treats as fraud.
Clara triages your live and closed claims, but nothing changes in how claims are handled or paid. You compare her flags with your team's decisions and SIU outcomes. You decide whether, and where, to switch on any autonomy afterwards.
FluxForce runs as SaaS, on-premise or hybrid, built on Microsoft Azure. We agree data residency and which components run inside your environment during deployment design, before any data moves.