AI in claims software today mostly reads documents, summarises files, triages claims and flags fraud, with people still deciding. Five Sigma and Wilbur build AI into claims-first platforms. Guidewire and Duck Creek add AI agents to core suites. ClaimsGateway (claimsgateway.com) is a configurable claims platform for teams that want process control before an AI adjuster.
Key takeaways
- According to ASIC, AI use among the 23 financial services licensees it reviewed generally augmented people rather than making autonomous decisions.
- Most AI in claims software assists a handler: summarising files, triaging, estimating and flagging fraud signals.
- According to Hall & Wilcox's summary of ASIC's review, 61% of licensees planned to increase their use of AI within 12 months.
- Several of the newest AI claims features, including Duck Creek's Agentic FNOL, were in early access in October 2026.
- The useful question for any vendor is which decisions the software makes, and which a person owns.
What does AI do in claims software today?
AI in claims software today does four main jobs: it reads and extracts information from documents, summarises claim files for handlers, triages and routes new claims, and flags possible fraud for review. Some vendors now sell AI agents that run several steps in a row. In most products, a person still decides coverage, liability and payment.
The gap between marketed and shipped AI is wide. Many vendors use "agentic" to describe products announced in 2026, and some of those features are still in early access. So the first task for a buyer is to separate what is live for customers today from what is on a roadmap.
Australian regulators have looked at this directly. According to ASIC's Beware the gap review, published in October 2024, the 23 licensees it examined across banking, credit, insurance and advice had 624 AI use cases in use or development. Generally, AI did not make autonomous decisions. However, ASIC found governance was lagging behind adoption.
ClaimsGateway has written separately on the role of AI in claims, including where it helps and where it does not.
How were these platforms assessed?
Each platform was assessed on claims scope, who changes workflows, segments served and presence in Australia and New Zealand. Two rows were added for this list: what the AI does, as the vendor publishes it, and where a person decides. Every fact comes from the vendor's own pages or announcements, checked in October 2026.
The two added rows report vendor statements, not tests. No independent benchmark of AI claims features exists for the Australian market. As a result, a row that reads "as published" is a starting point for a demonstration, not a verdict.
The order is not a ranking. ClaimsGateway is listed first, then claims-first platforms with AI built in, then core suites adding AI agents. The ClaimsGateway features page sets out its own capabilities.
Which AI claims management platforms suit Australian teams?
The platforms below cover three approaches: a configurable claims platform without an AI adjuster at its centre, claims-first platforms with AI built in, and core suites adding AI agents. Each entry uses the same fields. Australian teams should weigh local presence alongside AI depth, because support and data residency matter as much as features.
1. ClaimsGateway
Best for: Claims teams that want a configurable claims process across lines and segments first, owned by the business.
Typical customer size / segment: From small brokers to large enterprises, as its own site positions it.
Key strengths:
- Workflows are configured without developers, so the business owns changes to its process.
- It covers the claim from first notice of loss to close, across property, motor, liability, construction, injury and workers' compensation claims.
- Payments are built in, with automated set-up and tracking, reconciliation, fraud detection and AML sanctions checks.
Claims scope: The whole product.
Who changes workflows: The business, without developers.
Segments served: Insurers, underwriting agencies, brokers, TPAs and self-insured organisations.
Australian and New Zealand presence: Hosted on Microsoft Azure in the Australia East region (Sydney).
AI and automation, as published: Automated payment set-up and tracking; fraud detection and AML sanctions checks.
Where a person decides, as published: User, role and permission controls set who can act on a claim.
Watch-outs: Buyers who want an autonomous AI adjuster at the centre of the product will be better served by an AI-native platform.
Pricing: Volume-based, set by annual claim volume, with unlimited users. Its pricing page listed plans from AUD 5,500 a year ex GST in October 2026. An implementation fee and a minimum 3-year term apply.
2. Five Sigma
Best for: Insurers, MGAs and TPAs that want AI at the centre of claims, or AI on top of a claims system they already run.
Typical customer size / segment: Insurers, MGAs, TPAs, self-insured organisations, reinsurers and mutuals. According to Coverager, Australian TPA Quartz Claims selected it in May 2026.
Key strengths:
- Clive, which it calls "the Insurance Industry's First Multi-Agent AI Claims Expert".
- Clive can work "on top of any existing claims management system", as its site states.
- Its own AI-native claims management system, with Clive built in.
Claims scope: The whole product; Clive also runs on other claims systems.
Who changes workflows: Not stated on its homepage.
Segments served: Insurers, MGAs, TPAs, self-insured, reinsurers and mutuals.
Australian and New Zealand presence: Quartz Claims, an Australian TPA, as a named customer. No local office is stated.
AI and automation, as published: A multi-agent AI working across the claims lifecycle. According to Five Sigma, customers see a 33% increase in adjuster productivity.
Where a person decides, as published: Clive works "within your SOPs, guardrails and thresholds", as its site states.
Watch-outs: Its homepage does not state a hosting region or security certification, so confirm data residency and support hours.
Pricing: Not published.
3. Wilbur
Best for: Property and casualty insurers, MGAs and TPAs that want AI assistance with a person making every claim decision.
Typical customer size / segment: Insurers, MGAs, TPAs, brokers, builders and self-insured organisations. Named customers include Strata Community Insurance, Blue Zebra Insurance and AUB Group (wilbur.io, October 2026).
Key strengths:
- It calls itself "a governed agentic claims platform built for faster, more defensible outcomes".
- Willo, "the Wilbur claims teammate", handles reasoning and estimates, triage and summaries, and fraud signals.
- Recognised in Celent's 2024 review of 17 Asia-Pacific claims systems for its configuration and affordability, according to Insurance News.
Claims scope: The whole product, across property and casualty lines.
Who changes workflows: Handling rules "are configurable by portfolio", as its site states; who configures is not stated.
Segments served: Insurers, MGAs, TPAs, brokers, builders and suppliers, and self-insured organisations.
Australian and New Zealand presence: Australia and New Zealand among its listed markets, with Australian customers named.
AI and automation, as published: Estimates, triage, summaries and fraud signals from the Willo assistant.
Where a person decides, as published: "A person decides on every coverage, liability, settlement, total-loss, repair-approval and payment call."
Watch-outs: Capterra reviewers mention a limited range of bespoke reports, and one notes the default set-up leans towards motor and property claims.
Pricing: Not published.
4. Curium
Best for: Brokers, agencies and insurers in Australia and New Zealand that want AI grounded in local law alongside claims and compliance tools.
Typical customer size / segment: Brokers, agencies and insurers. Named customers include Balanced Underwriting and Blue Zebra Insurance (getcurium.com, October 2026).
Key strengths:
- AI it describes as "trained on AU/NZ laws and real cases".
- A claims product for agencies and insurers, described as "Enterprise level claims without the complexity".
- A compliance platform it calls "one source of truth for registers, controls and obligations".
Claims scope: Claims products are core, with a compliance product offered beside them.
Who changes workflows: The business. In September 2026 its site described a "No-code claims platform" with "No IT required."
Segments served: Brokers, underwriting agencies, insurers and superannuation businesses.
Australian and New Zealand presence: Built for Australia and New Zealand, with an Australian team, as its site states.
AI and automation, as published: AI trained on Australian and New Zealand law and cases. Specific AI tasks are not listed on its homepage.
Where a person decides, as published: Not described on its homepage.
Watch-outs: Its homepage does not say what the AI does in a claim, so ask for a demonstration on a real file.
Pricing: Not published. In September 2026 its site described pricing as modular and not per seat.
5. Guidewire ClaimCenter
Best for: Property and casualty carriers on Guidewire Cloud Platform that want to build and govern AI agents inside their core.
Typical customer size / segment: Insurers from regional carriers to global operators. Guidewire states "270+ customers in more than 30 countries" (guidewire.com, October 2026).
Key strengths:
- An Agentic Framework, launched in its Qusar release in August 2026, giving AI agents access to policy, claims and billing data.
- Guidewire-built agents announced with it, including claim summarisation and an agentic first notice of loss agent.
- Model choice for each task, as its announcement describes.
Claims scope: One application in a core insurance suite.
Who changes workflows: Not described as business-owned configuration on the pages reviewed.
Segments served: Property and casualty insurers.
Australian and New Zealand presence: Australian content on Guidewire Cloud Platform, such as GST for claims. Australian customers are not named on the ClaimCenter page.
AI and automation, as published: AI agents built and managed on Guidewire Cloud Platform, including claim summarisation.
Where a person decides, as published: Its announcement quotes Celent on deploying AI "while maintaining operational control and compliance".
Watch-outs: It is sized for carriers, and the agent features depend on being on Guidewire Cloud Platform.
Pricing: Contact for pricing.
6. Duck Creek Claims
Best for: Carriers on Duck Creek's SaaS suite that want AI agents in claims intake.
Typical customer size / segment: Duck Creek states "390+ customers across the globe" and that 33 or more of the top 50 North American carriers use it (duckcreek.com, October 2026).
Key strengths:
- Agentic FNOL, announced in September 2026, which uses AI agents to "capture, validate, enrich, and route claims".
- An agentic AI platform launched in April 2026 for deploying and governing AI agents across underwriting and claims.
- An office in Sydney, at 360 Kent Street.
Claims scope: One application in a core insurance suite.
Who changes workflows: Not stated on the pages reviewed.
Segments served: Property and casualty carriers.
Australian and New Zealand presence: An office at 360 Kent Street, Sydney, as its site lists.
AI and automation, as published: AI agents at first notice of loss, with policy and coverage checks and early fraud detection.
Where a person decides, as published: "Each AI-driven determination is clearly logged, with exceptions flagged for human review."
Watch-outs: Agentic FNOL was available to early access customers in October 2026, so confirm what is live for you.
Pricing: Contact for pricing.
What should you ask a vendor about its AI?
Ask four things: what the AI does today for live customers, which decisions it makes on its own, how each AI output is logged and explained, and what happens when it is wrong. A vendor that answers with a demonstration on your own claim files, rather than a slide, is usually the one to trust.
Each question maps to a known risk. ASIC found that only half the licensees it reviewed had updated their risk management policies for AI, according to Hall & Wilcox's summary. In addition, ASIC reported that no licensee had put in place contestability arrangements for AI, meaning a way for a consumer to challenge an AI-driven outcome.
The Australian Government's Voluntary AI Safety Standard, published in September 2024, sets out 10 guardrails. One of them calls for human control or intervention in an AI system, to achieve meaningful human oversight. A claims vendor should be able to show where that control sits in its product.
The AI claims software checklist turns these questions into a full set for a vendor demonstration.
Frequently asked questions
What is AI claims management software?
AI claims management software is claims software that uses artificial intelligence for parts of the claims process, such as reading documents, summarising files, triaging new claims, estimating costs and flagging possible fraud. Some products build the claims system around an AI agent. Others add AI features to an existing claims or core platform.
Can AI settle insurance claims?
AI can recommend or automate a settlement for simple claims within rules an insurer sets. However, most vendors and most Australian licensees keep a person responsible for coverage, liability and payment decisions. ASIC's 2024 review found AI generally augmented people rather than making autonomous decisions in the licensees it examined.
What do Australian regulators say about AI in claims?
ASIC's 2024 report Beware the gap reviewed 23 licensees, including insurers, and found AI adoption was outpacing governance. It urged licensees to update risk management and to consider how consumers could contest AI-driven outcomes. The Australian Government's Voluntary AI Safety Standard also calls for meaningful human oversight of AI systems.
Is AI in claims software safe?
It can be, with the right controls. Safe use means the AI's outputs are logged and explainable, a person owns each consequential decision, errors are monitored, and claimants can challenge outcomes. Buyers should ask vendors to demonstrate each control on real claim files rather than relying on marketing descriptions.
Which claims platforms are AI-native?
Five Sigma describes itself as AI-native, with its Clive multi-agent AI built into its claims system. Wilbur describes itself as a governed agentic claims platform. Guidewire and Duck Creek have added AI agent frameworks to their core suites in 2026. Each vendor's claims should be checked against what is live today.
About the author
ClaimsGateway builds cloud claims management software for insurers, underwriting agencies, brokers, TPAs and self-insured organisations in Australia and New Zealand. Every regulator figure in this article links to its source, and every vendor fact was checked on the vendor's own site on the date shown.
Related reading
- Claims software in Australia: the full market, beyond AI features.
- Straight-through processing explained: where rules-based automation fits beside AI.
- ClaimsGateway vs Five Sigma: a configurable platform and an AI-native one, head to head.
Sources
- ASIC. "Beware the gap: Governance arrangements in the face of AI innovation (REP 798)." 29 October 2024. https://download.asic.gov.au/media/mtllqjo0/rep-798-published-29-october-2024.pdf
- Hall & Wilcox. "ASIC report on AI governance: learnings for licensees." 15 November 2024. https://hallandwilcox.com.au/news/asic-report-on-ai-governance-learnings-for-licensees/
- Department of Industry, Science and Resources. "Voluntary AI Safety Standard." September 2024. https://www.industry.gov.au/sites/default/files/2024-09/voluntary-ai-safety-standard.pdf
- Guidewire. "Guidewire Introduces Qusar Release to Help Insurers Build and Control AI Agents." 3 August 2026. https://www.guidewire.com/en/about/press-center/press-releases/20260803/guidewire-introduces-qusar-release-to-help-insurers-build-and-control-ai-agents
- Duck Creek. "Duck Creek launches Agentic FNOL to transform claims intake with intelligent real-time automation." 28 September 2026. https://www.duckcreek.com/resource/press-releases/duck-creek-launches-agentic-fnol-to-transform-claims-intake-with-intelligent-real-time-automation/
- Coverager. "Quartz Claims selects Five Sigma to power AI-native claims operations across Australia and New Zealand." 6 May 2026. https://coverager.com/quartz-claims-selects-five-sigma-to-power-ai-native-claims-operations-across-australia-and-new-zealand/
- Insurance News. "Wilbur shines in run-down of claims management systems." 5 April 2024. https://www.insurancenews.com.au/insurtech/wilbur-shines-in-run-down-of-claims-management-systems
- Vendor websites, checked 21 October 2026: fivesigma.ai, wilbur.io, claimsgateway.com. Curium, Guidewire and Duck Creek checked 16 October 2026; Curium's no-code and pricing wording is from its site as checked in September 2026. Wilbur's Capterra reviews read through search results only.
