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Processes

What will AGI do for Set program thresholds to match investigation unit capacity?

A capacity review cycle begins or the investigation unit reports a sustained backlog or excess availability.

Trigger
A capacity review cycle begins or the investigation unit reports a sustained backlog or excess availability.
Outcome
Investigation thresholds are updated in the claims system to yield a sustainable volume of flagged cases.

The work itself

Grounded Work Profile

Measured by

  • Investigator Utilization RateprocessProfile
  • Investigation Backlog VolumeprocessProfile
  • False Positive RateprocessProfile
  • Threshold Adjustment Cycle TimeprocessProfile

Key steps

  • Assess current investigation unit workload and available capacityprocessProfile
  • Review historical flag rates and false-positive metricsprocessProfile
  • Model proposed threshold changes against past claim volumesprocessProfile
  • Approve new threshold parametersprocessProfile
  • Update rules engines with new threshold valuesprocessProfile
  • Monitor incoming queues to verify capacity alignmentprocessProfile

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Four ways AGI delivers for Set program thresholds to match investigation unit capacity

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  • Business-as-Code

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Value flow

How Set program thresholds to match investigation unit capacity connects

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