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Processes

What will AGI do for Perform claim policy management?

AI-deliverabilitydigital

With no child occupations seeded, the scalar is derived from the process name 'Perform claim policy management' and its anchor within the 'Direct Health and Medical Insurance Carriers' industry. Managing claims policies is inherently an administrative, information-processing function—centered on document review, data verification, and rules-based decisions—which maps to a highly digital, remotely addressable back-office workload.

Changes in medical guidelines, fee schedules, or regulatory requirements initiate the need to update claim adjudication rules.

Trigger
Changes in medical guidelines, fee schedules, or regulatory requirements initiate the need to update claim adjudication rules.
Outcome
Clinical and administrative claim policies are configured, tested, and deployed to govern automated claims adjudication.

The work itself

Grounded Work Profile

Measured by

  • Policy Implementation Cycle TimeprocessProfile
  • Rule Configuration AccuracyprocessProfile
  • Payment Error RateprocessProfile
  • Auto-Adjudication RateprocessProfile

Key steps

  • Identify required policy or fee schedule updatesprocessProfile
  • Draft clinical and administrative policy changesprocessProfile
  • Obtain medical director and compliance approvalsprocessProfile
  • Configure policy rules in the claims adjudication systemprocessProfile
  • Test rule logic against historical claimsprocessProfile
  • Deploy updated policies to the production engineprocessProfile
  • Monitor rule execution for payment accuracyprocessProfile

How AGI delivers it

Four ways AGI delivers for Perform claim policy management

  • Autonomous Agents as digital employees

    Hire a digital employee that does the job under earned, supervised autonomy.

    Agents.do

  • Services-as-Software

    Get the professional outcome delivered as software, priced on results, not headcount.

    Services.do

  • Business-as-Code

    Encode how your work runs, once, as software that executes itself.

    Platform.do

Go deeper

Explore Perform claim policy management

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