Processes

What will AGI do for Route claims for processing?

A validated medical or pharmacy claim is transferred from the intake gateway to the core administrative system.

Trigger: A validated medical or pharmacy claim is transferred from the intake gateway to the core administrative system.
Outcome: The claim is deposited into the correct automated adjudication engine, specialty queue, or manual examiner workflow.

The work itself

Grounded Work Profile

Ingest validated claim data from the intake systemprocessProfile
Parse claim attributes including provider type, member plan, and diagnosis codesprocessProfile
Apply routing algorithms to determine processing requirementsprocessProfile
Separate claims requiring medical review, coordination of benefits, or fraud investigationprocessProfile
Assign the claim to the designated processing queue or automated engineprocessProfile

How AGI delivers it

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

Value flow

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