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🔍 '''Triage''' in insurance refers to the systematic process of evaluating and prioritizing incoming [[Definition:Claim | claims]], [[Definition:Submission | submissions]], or service requests so that each item is routed to the appropriate handler, workflow, or decision path based on its complexity, urgency, and potential financial impact. Borrowed from emergency medicine, the concept has become central to modern [[Definition:Claims management | claims management]] and [[Definition:Underwriting | underwriting]] operations, where high volumes demand rapid, consistent sorting to allocate resources effectively.

⚙️ In a claims operation, triage typically occurs at [[Definition:First notice of loss (FNOL) | first notice of loss]], when an adjuster or automated system assesses key data points — injury severity, estimated [[Definition:Reserve | reserve]] amount, coverage complexity, and [[Definition:Fraud | fraud]] indicators — to assign the claim to a fast-track, standard, or complex handling queue. Many [[Definition:Insurtech | insurtech]] platforms now embed [[Definition:Artificial intelligence (AI) | artificial intelligence]] and [[Definition:Machine learning | machine learning]] models directly into the triage step, analyzing structured and unstructured data in real time to predict claim severity and flag anomalies. On the underwriting side, triage determines whether a [[Definition:Submission | submission]] can be auto-quoted, needs manual review by a senior [[Definition:Underwriter | underwriter]], or should be declined outright, dramatically accelerating [[Definition:Turnaround time | turnaround time]] for [[Definition:Broker | brokers]] and [[Definition:Policyholder | policyholders]].

📈 Effective triage directly influences an insurer's [[Definition:Loss ratio | loss ratio]], [[Definition:Expense ratio | expense ratio]], and customer satisfaction. By channeling straightforward cases into streamlined workflows and reserving specialist attention for high-severity or suspicious matters, carriers reduce cycle times, catch [[Definition:Leakage | leakage]] early, and deploy experienced staff where they add the most value. Poor triage, conversely, leads to bottlenecks, misallocated reserves, and delayed settlements — outcomes that erode both profitability and market reputation. As the industry increasingly embraces [[Definition:Straight-through processing (STP) | straight-through processing]], the triage layer has become the critical gatekeeper that determines how much human intervention a transaction truly requires.

'''Related concepts'''
{{Div col|colwidth=20em}}
* [[Definition:First notice of loss (FNOL)]]
* [[Definition:Claims management]]
* [[Definition:Straight-through processing (STP)]]
* [[Definition:Artificial intelligence (AI)]]
* [[Definition:Underwriting]]
* [[Definition:Fraud detection]]
{{Div col end}}

Definition:Triage - Revision history

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