Processes

What will AGI do for Perform research and resolve inquiries?

A member, provider, or broker submits a complex question, grievance, or appeal that requires escalation beyond tier-one support.

Trigger: A member, provider, or broker submits a complex question, grievance, or appeal that requires escalation beyond tier-one support.
Outcome: The inquiry is investigated, a definitive resolution is applied to the account, and the stakeholder is notified of the outcome.

The work itself

Grounded Work Profile

Log and classify the escalated inquiry or appealprocessProfile
Assign the case to a dedicated research specialistprocessProfile
Extract policy terms, medical records, and historical claims dataprocessProfile
Evaluate the collected data against coverage guidelines and state regulationsprocessProfile
Determine the appropriate resolution or claims adjustmentprocessProfile
Update the policy administration and claims systemsprocessProfile
Draft and send the final determination notice to the stakeholderprocessProfile

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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