Processes

What will AGI do for Develop claim policy rules?

A regulatory update, new health plan design, or scheduled clinical review initiates the need for a new or modified claim adjudication rule.

Trigger: A regulatory update, new health plan design, or scheduled clinical review initiates the need for a new or modified claim adjudication rule.
Outcome: Approved claim policy rules are active in the core adjudication system to accurately automate and standardize claims processing.

The work itself

Grounded Work Profile

Identify the need for a new or updated claim policyprocessProfile
Draft clinical and administrative policy logic based on medical guidelines and contract termsprocessProfile
Assess the financial and operational impact of the proposed rule changesprocessProfile
Obtain medical and administrative committee approval for the policyprocessProfile
Translate the approved policy into system-executable adjudication rulesprocessProfile
Test rule execution against historical claim data in a staging environmentprocessProfile
Deploy the validated rules to the production claim processing systemprocessProfile

How AGI delivers it

Services-as-Software
Get the professional outcome delivered as software, priced on results, not headcount.
Services.do
Autonomous Agents as digital employees
Hire a digital employee that does the job under earned, supervised autonomy.
Agents.do
Business-as-Code
Encode how your work runs, once, as software that executes itself.
Platform.do

Value flow

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