Claims automation software uses rules and, increasingly, AI to route tasks, check claims, make payments and move simple claims through without manual steps. ClaimsGateway (claimsgateway.com) automates payments and fraud checks inside workflows the business configures. Five Sigma and Wilbur add AI assistance. Guidewire and Duck Creek automate inside core suites. People still decide the consequential calls.
Key takeaways
- Automation and AI are different: automation follows rules a person wrote, while AI makes predictions a person should check.
- According to McKinsey, the technology for full straight-through processing of simple, predictable claims already exists.
- According to the Insurance Council of Australia, insurers received more than 22,000 claims within days of ex-Tropical Cyclone Alfred in 2025, the kind of surge automation is meant to absorb.
- The safest first targets are payments, task routing and checks, not coverage decisions.
- According to Hall & Wilcox's summary of ASIC's 2024 review, 61% of licensees planned to increase their use of AI within 12 months.
What does claims automation cover?
Claims automation covers the steps software can do without a person: routing tasks to the right handler, checking a claim against rules, verifying policy details, flagging possible fraud, setting up and reconciling payments, and moving the simplest claims straight through. It ranges from simple rules to AI models that read documents and suggest decisions.
Rules-based automation is the older and more predictable kind. A person writes the rule, such as "claims under a set value with a receipt go to the fast-track queue", and the software applies it the same way every time. Because the rule is written down, it can be audited.
AI-based automation is newer. A model reads a document, summarises a file or scores fraud risk, and its output is a prediction rather than a rule. That makes it powerful for unstructured work, but harder to explain, so most vendors keep a person in the loop.
Straight-through processing is the far end of automation, where a simple claim is lodged, checked and paid with no manual step. The guide to straight-through processing covers when that is safe.
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 each platform automates, as its vendor publishes it, and where a person decides. Every fact comes from the vendor's own pages or announcements, checked in October 2026.
The "what is automated" row separates rules from AI wherever the vendor makes the distinction. However, vendors describe automation in very different terms, so the row quotes them rather than scoring them.
The order is not a ranking. ClaimsGateway is listed first, then claims-first platforms with AI assistance, then core suites. The ClaimsGateway features page sets out its own capabilities.
Which claims automation software suits insurers and TPAs?
The platforms below cover three approaches: a configurable claims platform with payment and fraud automation, claims-first platforms that add AI assistance, and core suites with automation and AI agents built in. Each entry uses the same fields. Insurers and TPAs should weigh how much of their own process they can automate without the vendor.
1. ClaimsGateway
Best for: Insurers, TPAs and agencies that want to automate payments and checks inside claims workflows their own people configure.
Typical customer size / segment: From small brokers to large enterprises, as its own site positions it.
Key strengths:
- Automated payment set-up and tracking, payment histories and reconciliation through an integrated payment system.
- Fraud detection and AML sanctions checks, alongside payments.
- Workflows are configured without developers, so the business owns changes to what happens at each step.
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).
What is automated, as published: Payment set-up, tracking and reconciliation; 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: Low-volume teams with one claims handler may not need automation software yet.
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 agents to take on adjuster work, inside Five Sigma's platform or on top of another one.
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.
- According to Five Sigma, its customers see a 33% increase in adjuster productivity.
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.
What is automated, as published: Claims workflows, through a multi-agent AI across the claims lifecycle.
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 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 estimates, triage, summaries and fraud signals.
- Handling rules "are configurable by portfolio", as its site states.
Claims scope: The whole product, across property and casualty lines.
Who changes workflows: Configurable by portfolio; 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.
What is automated, as published: Triage, summaries, estimates 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. Duck Creek Claims
Best for: Carriers on Duck Creek's SaaS suite that want automated claims workflows and AI agents at 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:
- Claims resolution "through intelligent automation and streamlined, business-led workflows", as its claims page describes it.
- It states that an assignment or rule change takes "<1 days".
- Agentic FNOL, announced in September 2026 for early access customers, to "capture, validate, enrich, and route claims".
Claims scope: One application in a core insurance suite.
Who changes workflows: "Business-led workflows" on "a low-code foundation", as its site states.
Segments served: Property and casualty carriers.
Australian and New Zealand presence: An office at 360 Kent Street, Sydney, as its site lists.
What is automated, as published: Claims workflows and rules, with AI agents at first notice of loss.
Where a person decides, as published: "Each AI-driven determination is clearly logged, with exceptions flagged for human review."
Watch-outs: Agentic FNOL was in early access in October 2026, and the suite is sized for carriers.
Pricing: Contact for pricing.
5. Guidewire ClaimCenter
Best for: Property and casualty carriers on Guidewire Cloud Platform that want to automate multi-step claims processes with AI agents.
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:
- Lifecycle depth, which Guidewire describes as running "From claim intake to closure".
- An Agentic Framework, launched in August 2026, so that multi-step processes "run automatically", according to its announcement.
- Claim payments tied to reserve lines, as its developer documentation 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.
What is automated, as published: Claims processes inside the suite, with AI agents such as claim summarisation added in 2026.
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.
What should you automate first in claims?
Automate first the steps that are high in volume, low in judgement and easy to check: task routing, acknowledgements, policy lookups, payment set-up and reconciliation, and fraud and sanctions screening. Leave coverage, liability and settlement decisions with people until the rules are proven. Then widen automation one claim type at a time.
Payments are often the best first target. A payment keyed by hand into a separate system is slow and error-prone, and the record of it sits apart from the claim. Automating set-up and reconciliation inside the claims platform removes that re-keying.
Checks come next. Screening every payee against sanctions lists, and every claim for duplicates and red flags, is repetitive work that software does consistently. Anything that fails a check should go to a person, not be declined by the system.
Surges make the case for automation clearest. According to the Insurance Council of Australia, insurers received more than 22,000 claims by 11 March 2025, within days of ex-Tropical Cyclone Alfred. Automated routing and acknowledgement let handlers spend their time on the claims that need judgement. The guide to no-code claims platforms covers how teams set their own rules.
Frequently asked questions
What is automated claims processing?
Automated claims processing is the use of software to carry out claims steps without manual work, such as routing tasks, checking claims against rules, screening for fraud and sanctions, and setting up payments. At its fullest, simple claims are processed straight through from lodgement to payment. Complex claims still need people.
What parts of a claim can be automated?
Most of the administrative steps can be automated: intake and acknowledgement, policy lookup, task routing, document reading, fraud and sanctions checks, payment set-up and reconciliation, and status updates. Coverage, liability and settlement decisions on complex claims are usually kept with people, with automation preparing the information they need.
Does automation reduce claims staff?
Automation usually changes claims work more than it removes it. It takes over repetitive steps, such as re-keying and routing, so handlers spend more time on complex claims and on claimants who need help. Teams often use it to absorb growth or catastrophe surges without adding staff, rather than to reduce headcount.
Is automation the same as AI?
No. Rules-based automation follows rules that people write, so it behaves the same way every time and is easy to audit. AI uses models that make predictions, such as reading a document or scoring fraud risk, which suits unstructured work but needs human checks. Many claims platforms now combine both.
What is straight-through processing?
Straight-through processing is handling a claim from lodgement to payment with no manual step. The system checks the claim against set rules and, if every check passes, approves and pays it. It suits simple, low-value, well-evidenced claims, while claims that fail a check or need judgement drop out to a handler.
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
- AI claims management software: platforms compared on what their AI does.
- Salesforce-integrated claims software: automation that reaches into a CRM.
- Claims payment software: the payment step most teams automate first.
Sources
- McKinsey & Company. "Claims 2030: Dream or reality?" Checked 21 October 2026. https://www.mckinsey.com/capabilities/operations/our-insights/claims-2030-dream-or-reality
- Reinsurance News. "Insurers receive over 22,000 claims following ex-Tropical Cyclone Alfred: ICA." 11 March 2025. https://www.reinsurancene.ws/insurers-receive-over-22000-claims-following-ex-tropical-cyclone-alfred-ica/
- 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/
- 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/
- Duck Creek. "Claims" and "Duck Creek launches Agentic FNOL." Checked 21 October 2026. https://www.duckcreek.com/products/claims/
- 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
- Vendor websites, checked 21 October 2026: fivesigma.ai, wilbur.io, claimsgateway.com. Wilbur's Capterra reviews read through search results only.
