Solutions

Copilots and agents for regulated operations

Each solution ships with explainability, evaluation harnesses and audit evidence — designed to pass risk review, not just a demo.

01

Explainable Claims Decision Copilot

Adjudication support that shows its work — every recommendation cites the policy clause, clinical guideline and claim artefact behind it.

Pre-auth claims

  • Medical necessity checks
  • Network and tariff validation
  • Turnaround under minutes

Reimbursement claims

  • Bill and discharge summary parsing
  • Deduction reasoning
  • Query letter drafting

Policy validation

  • Waiting periods and exclusions
  • Sub-limit and co-pay logic
  • Clause-level citations
02

Fraud Detection Agent

A multi-agent investigation workflow that triages suspicious claims and hands investigators an evidence pack, not just a score.

Suspicious claim detection

  • Provider and network pattern analysis
  • Duplicate and upcoding signals
  • Anomaly narratives

Risk scoring

  • Explainable score drivers
  • Configurable thresholds
  • Case routing to SIU
03

Customer Service AI Agent

Grounded conversational support across voice, chat and email — no hallucinated policy answers.

Policy inquiries

  • Coverage and exclusion answers
  • Renewal and endorsement guidance
  • Multilingual support

Claims status

  • Real-time status lookup
  • Document deficiency prompts
  • Escalation with full context
04

Underwriting Copilot

Faster, more consistent risk decisions built on structured extraction from unstructured submissions.

Risk assessment

  • Guideline-aligned recommendations
  • Comparable case retrieval
  • Referral rationale

Document analysis

  • Medical report extraction
  • Financial statement parsing
  • Discrepancy flags
05

AI Knowledge Assistant

Enterprise RAG across policies, SOPs, circulars and clinical guidelines with role-based access control.

Retrieval

  • Hybrid vector and keyword search
  • Access-gated corpora
  • Freshness and versioning

Governance

  • Answer citations
  • Prompt and response logging
  • PII redaction

Which use case should you start with?

Bring your top three candidates — we will size effort, risk and ROI in a single working session.

Book a consultation