Claims handlers
chasing documents and reassigning files manually
INSURANCE
Every claim reaches the right adjuster. Every SLA gets tracked.
Ortoo brings a single coordination layer to claims and underwriting teams: inbound cases are tracked against SLAs, context travels with each record, and nothing sits in a manual queue.
Ortoo Orchestrator coordinates your existing Salesforce automations, routing rules, and AI so that claims, submissions, and policy enquiries are handled consistently, with an audit trail on every step.
- 100% Salesforce native
- Full audit trail on every step
- AI under governance
- Pricing per work-item
FNOLClaim received via API
ValidationPolicy verified
RoutingAdjuster: P. Khan
ActionReserve set
OutcomeCycle time -38%
Trusted by insurance teams running complex Salesforce operations
THE REALITY
Not short on automation tools. Short on control.
Where the work gets stuck
-
-
Adjusters
coordinating across systems instead of adjudicating
-
Underwriters
waiting on context that exists somewhere in the stack
-
Compliance teams
reconciling audit trails the systems don't produce cleanly
Claims handlers spend their morning chasing missing documents, reassigning files between queues, and escalating cases that should have escalated themselves. Underwriters wait on context to make decisions the system already has. Compliance teams reconcile audit trails across systems that don't talk to each other the way regulators expect.
The systems run. The cost of holding it together is paid by the people who should be adjudicating, underwriting, and serving customers, not coordinating systems.
WHERE WORKFLOWS BREAK
The pattern is consistent across insurance operations.
The systems are fine. The problem is execution across them: the pieces do not operate as one system, and as exceptions, regulatory updates, and AI tools are added, the gaps grow.
They don't coordinate routing, escalation, and approval as one workflow.
Reassign this claim to the senior adjuster, gather the policy context, and notify the broker.
Use playbookRoute to queue
WHY INSURANCE IS DIFFERENT
Regulated. Document-heavy. Multi-party. Audit-trailed.
The pattern that creates this problem is also what makes insurance distinctive: every workflow touches regulation, every claim involves documents, every decision is reviewed. Volume grows during peak events; headcount does not scale at the same rate.
Every workflow is regulated
Routing, decisions, communications, settlements; each has compliance implications. Workflows need to run consistently and produce an auditable trail. Generic automation doesn't meet that bar.
Documents drive the workflow
A claim is a file of documents. An underwriting decision is interpretation across submissions and history. AI extracts; coordinating what follows is what was missing.
Multiple parties, every transaction
Insured, broker, adjuster, underwriter, claims handler, third-party administrators. Workflows that depend on one team noticing the handoff break as soon as volume rises. Coordinated workflows don't.
AI governance is non-negotiable
Insurance teams are using AI for document extraction, claims triage, fraud detection. Whether AI decisions can be governed, traced, and explained isn't optional; it's a regulatory requirement.
HOW ORTOO FITS
One coordination layer across the insurance operation.
Ortoo Orchestrator defines how insurance workflows connect across claims systems, policy platforms, document tools, and AI capabilities already in place. You stop paying the coordination cost of holding it together manually.
Claims operations
FNOL intake, triage, adjuster assignment, SLA management, escalation, and settlement. Insurance Claims Processing handles the common patterns out of the box.
ExploreUnderwriting and policy
New business workflows, underwriting decisions, policy issuance, endorsements, renewals, mid-term changes. Context gathers automatically; exceptions surface for review with full operational context.
ExploreCustomer communications
Inbound emails, escalations, complaints, multi-channel operations. Compliant capture, automated triage, and coordinated handoffs across customer-facing and back-office teams.
ExploreEXAMPLE WORKFLOWS
What gets resolved, in insurance-operations terms.
Every claim, submission, and policy enquiry follows a consistent process. Deterministic where regulators require it, AI-assisted where interpretation adds value.
FNOLassigned adjuster
A loss notice arrives by email, portal, or partner integration. Documents are extracted, loss type and severity classified, and the right adjuster assigned by workload and territory. Manual triage stops being the first hour of every day.
FNOLTriageAdjuster
Claimsettlement
Reserve setting, investigation, coverage verification, approval, and settlement each run as defined steps. SLA risks, severity changes, and fraud signals trigger escalations automatically. Adjusters adjudicate; the workflow coordinates.
ReserveApprovalSettlement
New business submissionbind
A broker submission arrives. Loss history, account data, and external risk signals are gathered before the underwriter sees it. Decisions run as defined steps; exceptions surface with full context.
SubmissionContextBind
Policy changecompliant update
A mid-term change comes in. Coverage implications, regulatory requirements, and downstream billing impacts are checked automatically. Approvals run as defined steps; the audit trail is generated throughout.
ChangeChecksAudit
AI INSIDE COORDINATED OPERATIONS
AI speeds up claims work. Every decision still has to stand up to an audit.
Insurance teams are adopting AI for real reasons: document extraction, claims triage, fraud signals, customer summarization. The pattern that emerges: AI tools work well on their step, then propagate whatever they produced into a workflow that wasn't designed to coordinate with them.
Where AI shows up uncoordinated
What AI does
What happens next
-
Document AI extracts claim data
the claim still sits while someone routes it manually
-
Fraud scoring flags a claim
nothing downstream is configured to triage the flag
-
AI triage classifies severity
the routing system uses last quarter's rules
-
Generative AI drafts a customer reply
compliance can't trace what was sent or why
In Ortoo Orchestrator, AI contributes where interpretation adds value: document extraction, claim classification, context summarization, anomaly detection. The workflow that follows stays governed, deterministic where regulators require it, traceable throughout. Ortoo supports any LLM provider, and any connection to an external model is explicitly configured.
AI extracts documents, classifies claims, and flags anomalies. The gaps between them are what auditors find.
ARCHITECTURE CONTEXT
Native to Salesforce. Compatible with Insurance Cloud and Financial Services Cloud.
All data remains within your Salesforce environment. Ortoo Orchestrator runs on the existing data model, security model, and automation. No new system of record. No data duplication. The audit trail lives where compliance teams already look for it.
Where workflows reach external systems, a policy administration platform, claims management system, document repository, or partner integrations, Ortoo Orchestrator handles those callouts inside the same workflow definition.
Coordination layer
Ortoo Orchestrator defines and runs workflows
Salesforce platform
Insurance Cloud, Financial Services Cloud, Flow, Omni-Channel, Agentforce
External stack
Policy admin, claims systems, document platforms, partner APIs
CUSTOMER IN ACTION
Insurance in action: Reliance Matrix
Reliance Matrix
"Email-to-Anything solved that gap that Salesforce has between standard email management features and what's possible with custom objects."
Marie Reddy, Manager, Salesforce Solutions, Reliance Matrix
24h
Quote turnaround
1
System of record
Record
Sales performance
Bespoke not blocked
Email-driven intake works against custom objects and Reliance Matrix's pre-sales process, not just standard records.
One place to look
Salesforce becomes the live workflow hub for broker and customer conversations, not just a repository.
Faster, traceable quotes
Quote turnaround dropped from 10 days to 24 hours, with full transparency across every step.
FAQ
Common questions from insurance operations leaders.
Claims and policy admin systems run workflows inside themselves. The pain is in the workflow that crosses both, plus underwriting, communications, AI tools, and partner integrations. Ortoo Orchestrator coordinates that crossing; it works with existing systems, not against them.
Get started
Make your insurance workflows run coordinated.
Book a 30-minute session. We'll map one operational workflow, claims, underwriting, or policy administration, and identify where orchestration changes the outcome.
Native Salesforce installStart with one workflowPricing follows work, not tokens
RELATED
Related pages
Solution
Service workflow orchestration
Claims, case management, and customer service operations end to end.
Open SolutionRevenue workflow orchestration
Broker-facing and agent-facing workflows from intake to close.
Open IndustryFinancial Services
Adjacent to insurance; wealth, banking, and life insurance cross-overs.
Open CapabilityIntelligent case routing
Multi-factor routing for claims, cases, and service queues.
Open CapabilityDistribute emails from Salesforce
Email-driven intake workflows, the foundation of the Reliance Matrix solution.
Open ProductEmail-to-Anything
The email orchestration capability inside Ortoo Orchestrator.
Open