Health Payors & TPAs
Faster, cleaner claims with your people in control.
Our teams run claims processing, adjudication support and calling for payors and third-party administrators. AI agents handle the data entry, follow-ups and checks.
claims-intake-agent · audit log
- INTAKEReceived invoice · Portuguese · PDF scan
- OCRDocument classified as hospital invoice
- TRANSLATELine items translated to English
- EXTRACTProvider, dates, line items, currency captured
- CHECKPolicy active · no duplicate found
- FLAGRoom charge above contracted rate, reason attached
- REVIEWAssigned to bill reviewer for confirmation
- DONEDecision-ready claim · full audit trail
The challenge
What slows operations down
Unstructured documents
Claims arrive as scans and PDFs that must be read, keyed and checked by hand.
Consistency at volume
Applying policy rules the same way across adjudicators is hard as volumes grow.
Call volumes
Members and providers call for status updates that could be answered automatically.
What we deliver
Services run by our teams, supported by AI agents
Payor services
- Claims processing & data entry
- OCR document review
- Claims adjudication support
- Inbound & outbound calling
- Quality assurance
Cost containment
- Medical bill review
- Repricing support
- Duplicate and FWA flag review
AI agents
- Claims intake agent
- Adjudication-assist agent
- Voice agents for status calls
- QA assistant
Where agents help
Where AI agents help
Intake agent
Reads, classifies and structures claim documents for review.
Adjudication assist
Proposes a decision with clause citations. Adjudicators decide.
Voice agents
Handle 'where is my claim?' calls and proactive updates.
QA assistant
Scores every claim so reviewers sample the right ones.
FAQ
Common questions
Can you work in our claims platform?
Yes. Our teams and agents work inside your existing claims and case systems, under your access controls.
Who makes the claim decision?
Your adjudicators, always. Agents prepare the evidence and a recommendation, and your people make the decision.
Next step
Talk to our team
Sthiram · Efficiency with stability