ClaimSorted

What do they actually do

ClaimSorted is a tech-enabled third‑party administrator (TPA) that takes over end‑to‑end claims handling for insurers instead of selling software alone. They combine automation with trained claims specialists and operate for insurers and insurance programs across the US, UK and Europe, with reported partnerships with multiple carriers (ClaimSorted site, Vestbee).

A typical claim starts with intake via a white‑label form or integrations (API/SFTP). Documents and evidence are ingested, verified and checked for eligibility, with fraud‑detection and recovery/subrogation flags. Straightforward claims are auto‑processed; complex files are routed to human handlers trained on the client’s policy wording and brand tone. Policyholders use a portal to track and submit information, while insurers receive analytics and performance data via reports, SFTP or API (ClaimSorted site, Scout InsurTech interview, Vestbee).

They report that a large share of claims are handled automatically—roughly 50–60%—with the rest managed by human adjusters, aiming to speed decisions and reduce indemnity leakage through automation plus oversight (ClaimSorted site).

Who are their target customer(s)

• Mid‑sized insurers/carriers running in‑house claims operations: High operating costs, slow cycle times, and leakage from legacy processes. They need a partner to take over end‑to‑end claims handling with measurable KPIs and modern data feeds (ClaimSorted, YC profile).
• Digital insurers, MGAs and insurtechs without deep claims expertise: They need to launch and scale claims fast while keeping a consistent brand experience, but lack adjuster teams and tooling. A white‑label, combined automation‑plus‑human operation fills that gap (ClaimSorted, Scout InsurTech).
• Large carriers or programs focused on fraud reduction and recoveries: Existing systems struggle to detect fraud and surface recovery/subrogation opportunities across messy document flows. They want automated checks and flags to reduce leakage (ClaimSorted).
• Insurers/programs expanding into new countries (US, UK, EU): Standing up compliant local claims operations is slow and costly, delaying market entry. They need an operator that can run claims across regions with the right integrations and compliance (Vestbee, Atomico).
• Program administrators and TPAs needing variable claims capacity: Seasonal or volatile volumes create staffing swings and backlogs. They need overflow capacity with automation, trained ops, and clean data handoff (APIs/SFTP) to avoid hiring cycles (ClaimSorted, Vestbee).

How would they acquire their first 10, 50, and 100 customers

• First 10: Use YC and investor introductions to secure paid 3–6 month pilots with mid‑size carriers and MGAs in the US/UK/EU, replacing a defined slice of claims under clear KPIs (cycle time, automation rate, leakage) and white‑label intake.
• First 50: Hire experienced insurance sales and account managers, add broker/program/reinsurer referral partnerships, and use case studies with quantified ROI plus a turnkey onboarding playbook (integration templates, SLAs, training) to shorten sales cycles and sign annual contracts with phased ramps.
• First 100: List on marketplaces and embed with policy admin vendors/TPAs, run targeted conference field marketing, and offer self‑serve integration bundles, volume discounts, and capacity guarantees; in parallel, add local compliance/ops to open more geographies and standardize KPI reporting for renewals.

What is the rough total addressable market

Top-down context:

Global P&C premiums are about EUR 2.4T; North America and Western Europe represent ~70% of that. Using a US benchmark that claims‑handling expense is ~10% of premiums implies ~EUR 160–170B in annual claims‑handling spend in these regions (Allianz, NAIC).

Bottom-up calculation:

Apply ~10% claims‑handling expense to ~EUR 1.7T of P&C premiums in North America + Western Europe to get ~EUR 170B TAM; assume 30–50% is outsourceable to TPAs/tech‑enabled operators for a SAM of ~EUR 50–85B per year (Allianz, NAIC).

Assumptions:

• Focus on P&C claims handling in US + UK/Western Europe; health and other lines excluded.
• US claims‑handling expense ratio (~10% of premiums) is a reasonable proxy across target regions and lines.
• 30–50% of claims‑handling spend is practically outsourceable to TPAs/tech‑enabled operators.

Who are some of their notable competitors

• Sedgwick: Large incumbent TPA used for delegated authority and full claims administration, combining adjuster networks with its own digital tools—an at‑scale alternative for carriers considering outsourcing (delegated authority, claims automation/tools).
• Crawford & Company: Global loss adjuster and TPA offering end‑to‑end claims services and building digital products (e.g., Digital Desk, Turvi SaaS), blending deep adjusting experience with increasing automation (services, Digital Desk, Turvi).
• Tractable: AI vendor for damage detection and rapid estimates in auto/property claims. Not a TPA, but insurers can deploy its automation in‑house rather than outsourcing to an external operator (solutions).
• CCC Intelligent Solutions: Claims software and data provider (notably in auto) with cloud platforms, AI workflows, and subrogation automation; enables carriers to modernize in‑house instead of outsourcing (carriers, IX Cloud).
• Mitchell (Enlyte): Longstanding provider of estimating, review, and claims‑workflow tech (including AI‑enabled estimating and automated review) used by insurers to speed in‑house claims instead of moving to a third‑party operator (automated estimating, automated review).