Warehouse ingestion
The claim file and supporting documents land in a governed workspace inside the client's own environment.
The work
A third of claim-processing time, under the highest scrutiny.
Claim processing is where volume, manual effort, and regulatory exposure meet.
At the healthcare insurer we worked with, document-intensive claims consume roughly one-third of claim-processing time. Adjudication and document handling span disconnected systems with swivel-chair handoffs and inconsistent outcomes. Governance uncertainty has slowed AI adoption across the industry — and denials and documentation errors drive appeals, erode member trust, and strain loss ratios across the book.
This case study describes work with a leading healthcare insurer. All member, claimant, and health-related data stays masked and secure throughout the claim-handling process.
The results
Read, extracted, matched.
85%+
of key payment values extracted accurately and matched — AI level one disposition that turns the most human-intensive activity in claim processing into time and effort saved.
The extraction-and-matching workflow was built against claim records from real files, matched to a claim file built from sample data. Coverage determination runs in the insurer's existing claim process. The workflow is ready to deploy on your files, customized to your plan types and review rules.
The workflow
Five steps, no change to the claim system.
AI reads the claim
Scanned claim documents are parsed directly from their images — no manual re-keying.
Extraction with confidence scoring
Payment amounts, dates, and payer details are extracted and each value carries a confidence score.
File enrichment and matching
Extracted values are matched to the claim file, producing an enriched record.
Existing claim processing
The enriched file drops straight into the existing batch process — no change to the claim system.
Scope, stated plainly
Two of seven claim steps.
In the workflow
Covered in this workflow
Receiving the claim documents and extracting payment amounts; matching payment values to the claim file. The overwhelming majority of key payment values were read correctly across the test set.
In your claim process
Handled by your claim process
Determining coverage and payment responsibility, requesting additional documentation, validating member eligibility, calculating the payment amount, and submitting payment.
Stating the boundary keeps the benefit case credible when it is sized. The magnitudes of cost and cycle-time improvement are for the insurer's own operations to set against its baseline.
Human judgment at the center
Governed by design.
The same operating system runs the full insurance value stream — intake, adjudication, clinical review, and payments. Claim document extraction is one workflow on a platform with native connectors to systems of record, an immutable audit of every prompt, source, model, and output, and single-tenant compute and data inside the client's perimeter.
Processors move from data entry to the steps that need judgment: the record arrives pre-populated, and people stay in the loop for the decisions that matter.
The same operating system
Proven across insurance claim work.
The identical governed environment has delivered measured results on other insurance claim processes — including property & casualty claim automation, where a live implementation removed hundreds of manual entry steps per claim and refocused staff on the high-value steps in each file.
No client identity, private claim records, projected savings, or confidential implementation figures are published on this page.
See the P&C case study