Processes

What will AGI do for Provide explanation of benefits to members?

A submitted medical claim is successfully adjudicated and finalized by the insurance carrier.

Trigger: A submitted medical claim is successfully adjudicated and finalized by the insurance carrier.
Outcome: The member receives a clear Explanation of Benefits detailing covered services, plan payments, and their personal financial responsibility.

The work itself

Grounded Work Profile

Extract adjudicated claim data and coverage determinationsprocessProfile
Map financial totals to standardized Explanation of Benefits templatesprocessProfile
Apply member communication preferences for physical or digital deliveryprocessProfile
Generate the finalized Explanation of Benefits documentprocessProfile
Distribute the document via secure member portal or postal mailprocessProfile
Archive the document in the member correspondence 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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