Claims Automation Readiness Assessment: Is Your Operation Ready?

Most claims automation projects that fail do not fail because the technology did not work. They fail because the operation was not ready. The software was deployed into an environment where data was unstructured, processes were undocumented, the team lacked the skills to configure it, and no one had authority to make the decisions the implementation required. The technology worked fine. Everything else did not.

Readiness assessment before committing to a claims automation investment is not a bureaucratic exercise — it is the difference between a deployment that delivers measurable ROI in 90 days and one that becomes a two-year project with nothing to show for it.

This assessment covers ten dimensions of readiness. Score each dimension from 1 to 5, total your score, and use the interpretation guide at the end to understand where you stand and what to do about it.

How to score each dimension

For each dimension, score 1 if the description of the lowest level closely matches your current state, 5 if the highest level matches. Use intermediate scores for states in between. Be honest — this assessment is only useful if it reflects reality, not aspiration.

Dimension 1: Data quality

Score 1: Claims data is primarily in email, PDF attachments, and narrative notes. There is no structured database of claim fields. Extracting any analysis requires manual work.

Score 3: Some claims data is structured in a CMS or spreadsheet system, but it is incomplete, inconsistently populated, and not validated at entry.

Score 5: Claims data is stored in a structured system with defined fields, validation rules, and high completeness rates. You can query claims by type, date, value, outcome, and adjuster without manual compilation.

Data quality is the most common readiness blocker. Automation can extract and structure data from incoming documents, but it cannot fix historical data quality problems that predate the implementation. If your data is poor, plan for a data remediation phase before or alongside automation deployment.

Dimension 2: Process documentation

Score 1: Each adjuster handles claims according to their own method. There is no written process. "How we do it" exists only in the heads of experienced staff.

Score 3: High-level process guidelines exist, but they are not detailed enough to configure a workflow engine. Exceptions and edge cases are handled by individual judgement.

Score 5: Claims workflows are documented to decision-tree level — for each claim type, the steps, routing logic, decision criteria, escalation triggers, SLA requirements, and exception handling are written down and agreed upon.

Automation enforces process. If your process is not documented, you cannot automate it — you can only automate one adjuster's interpretation of it. Strong process documentation is the prerequisite for consistent, scalable automation.

Dimension 3: Technology stack

Score 1: Claims are managed through a combination of email, shared network drives, and spreadsheets. There is no claims management system in place.

Score 3: A claims management system is in place but it is legacy, lacks APIs, and has limited integration capability. Adding a new platform would require significant manual data migration.

Score 5: Current systems have APIs, are cloud-based or cloud-compatible, and your IT team has experience integrating systems. A new platform can be connected to existing infrastructure within weeks.

A modern technology stack does not mean you need everything already in place — it means your existing systems are integration-ready. Legacy systems with no APIs create significant implementation complexity that extends timelines and costs.

Dimension 4: Team capability

Score 1: The team has no experience with automation software. There is no one who can configure workflows, manage a SaaS platform, or troubleshoot integration issues without external consultants.

Score 3: One or two people on the team have experience with modern software platforms and could learn to configure and manage automation tools, but would need support.

Score 5: Multiple team members are comfortable with modern SaaS platforms. Someone in the team could own the automation platform — configure workflows, manage user access, analyse performance data, and drive continuous improvement — without constant vendor support.

Team capability determines the ongoing cost of ownership. A platform that requires vendor intervention for every configuration change is expensive and slow to evolve. A team that can own the platform internally drives much better long-term ROI.

Dimension 5: Compliance posture

Score 1: There are no formal audit trails, no documented evidence of claims decisions, and no ability to respond to a regulatory information request within 10 working days.

Score 3: Some audit trail exists but it is manual, incomplete, or stored in systems that are not tamper-resistant. Evidence production takes weeks of manual compilation.

Score 5: Complete, tamper-resistant audit trails exist for all claims. You can produce an FCA evidence package — decision logs, communication records, outcome data — within 24 hours of request.

Compliance posture affects which automation features you need most urgently. If your compliance posture is weak, audit trail automation should be your first priority — it delivers both immediate regulatory protection and the data infrastructure that subsequent automation builds on.

Dimension 6: Vendor relationships

Score 1: No vendor due diligence processes are in place. There are no standard DPA templates, no security assessment frameworks, and procurement of new software is slow and informal.

Score 3: Basic vendor assessment processes exist, but they are slow. A new SaaS platform procurement takes 6+ months to complete due diligence and contracting.

Score 5: Vendor assessment processes are defined and efficient. DPA templates, security questionnaires, and contracting processes are in place. A compliant SaaS platform can be contracted within 4–8 weeks.

Slow vendor relationships do not block automation but they delay it. If your procurement process takes 6 months, budget for that in your timeline planning.

Dimension 7: Claims volume

Score 1: Under 50 claims per month. Manual processing is feasible and the ROI from automation does not clearly justify the investment.

Score 3: 50–300 claims per month. Automation delivers measurable efficiency gains but may not be the highest priority investment.

Score 5: 300+ claims per month. Manual processing is creating bottlenecks, backlogs, or quality inconsistencies. Automation ROI is clear and immediate.

Volume is not the only factor — a firm processing 100 complex workers' compensation claims per month may benefit more from automation than one processing 500 routine motor claims. But volume is the primary driver of financial ROI, and operations below certain thresholds may find the investment difficult to justify on cost grounds alone.

Dimension 8: Current cycle time

Score 1: Average claims cycle time is under 3 days. Processes are already efficient. Speed alone is not a compelling automation driver.

Score 3: Average cycle time is 5–10 days. There are identifiable bottlenecks in document processing, adjuster assignment, or approval workflows.

Score 5: Average cycle time exceeds 10 days or varies significantly between adjusters. There are clear, addressable delays that automation would directly reduce.

Automation's impact on cycle time is one of its most compelling business cases. If your current cycle times are already fast, the ROI story is more about cost reduction and compliance than speed improvement.

Dimension 9: Executive sponsorship

Score 1: There is no C-level champion for claims automation. The initiative is being driven by operations or IT without board-level visibility or support.

Score 3: A senior manager supports the project but does not have budget authority or the ability to resolve cross-functional blockers (IT security objections, compliance requirements, vendor contracting delays).

Score 5: A C-level executive (CEO, COO, CTO) is actively sponsoring the project, has allocated budget, and has authority to make the decisions that the implementation requires.

Executive sponsorship is the single dimension most correlated with implementation success. Claims automation touches IT, operations, compliance, legal, and finance. Without executive authority to resolve conflicts between these functions, implementations stall. Projects without a C-level sponsor succeed by accident and fail by default.

Dimension 10: Budget alignment

Score 1: No budget has been allocated. Automation is being discussed as a future investment without funding.

Score 3: Budget exists for software licensing but not for implementation resources — internal staff time, integration work, data migration, or training.

Score 5: Total cost of ownership is understood and budgeted: software licensing, implementation resources, ongoing management, training, and the internal staff time the project will require. Budget is approved and allocated.

Underestimating implementation cost is extremely common. Software licensing is visible; the internal resources required to configure workflows, migrate data, train staff, and manage the rollout often are not. Firms that budget only for the software frequently run out of money and enthusiasm halfway through deployment.

Score interpretation

10–20: Significant preparation required. Your operation has foundational gaps that would cause an automation project to fail or underdeliver. Prioritise data quality improvement, process documentation, and executive sponsorship before committing to a platform. Use this period to define what "ready" looks like and build a 90-day preparation plan.

21–35: Ready to pilot. You have the foundations but gaps remain. Start with a focused pilot — one claim type, one line of business, or one specific workflow — that delivers measurable results without requiring the entire operation to be ready. Use the pilot to close gaps in team capability, process documentation, and data quality before scaling.

36–45: Ready for full implementation. Your operation has the foundations for a successful full deployment. The gaps are manageable — address the lowest-scoring dimensions as part of the implementation plan rather than before it. Set clear success metrics before you start and measure against them at 30, 60, and 90 days.

46–50: Automation is overdue. You have everything needed for a successful deployment and the delay is costing you. The efficiency losses, compliance exposure, and competitive disadvantage of manual processing are accumulating. Move quickly.

The three dimensions that matter most

If you score poorly across multiple dimensions, prioritise these three: executive sponsorship, process documentation, and data quality. They are the dimensions most consistently correlated with project failure when they are weak, and they are the ones most within your control to improve before a platform decision.

Executive sponsorship cannot be delegated or worked around. Process documentation cannot be skipped — you cannot configure what you have not defined. And data quality problems compound as you automate: garbage in, garbage out, at scale.

The good news is that improving these three dimensions does not require a technology investment. It requires internal discipline, leadership alignment, and dedicated time. An organisation that commits two months to process documentation and data remediation before selecting a platform will get dramatically better results than one that selects a platform first and discovers the gaps during deployment.

From assessment to action

This assessment is a starting point. The specific actions required depend on your particular gaps, your line of business, your regulatory environment, and your competitive position. A workers' compensation TPA has different readiness requirements than a personal lines carrier. A Lloyd's coverholder has different compliance dimensions than a UK retail broker.

Regure's claims automation platform is designed to work with operations at different readiness levels — from focused pilots for organisations building capability to full deployments for operations that are ready to move at scale. If you want a personalised readiness assessment for your specific operation, request a demo and we will walk through your specific context, identify your highest-impact starting points, and help you build a realistic implementation plan.