AGI.do

Services

What will AGI do for Claims payment processing or administration?

Services offered by suppliers (Third-Party Payers or Third-Party Administrators) who collect insurance premiums from various group clients, handle payment to service providers (health, dental, drug) and remit premiums collected back to insurance companies. In some cases, may act to pay on behalf of insurance company, and directly contact and maintain information with the group clients.

The work itself

Grounded Work Profile

Tools

  • Claims Management SystemserviceBlueprint
  • Payment Processing SystemserviceBlueprint
  • Adjudication EngineserviceBlueprint
  • Document Generation SystemserviceBlueprint
  • General Ledger SystemserviceBlueprint

Outputs

  • Payment Disbursement LedgerserviceBlueprint
  • Explanation of BenefitsserviceBlueprint

Measured by

  • Payment Error RateserviceBlueprint
  • Time to PaymentserviceBlueprint

Key steps

  • Receive approved settlementserviceBlueprint
  • Validate payee and banking detailserviceBlueprint
  • Apply deductibles and offsetsserviceBlueprint
  • Disburse claim paymentserviceBlueprint
  • Issue payment noticeserviceBlueprint
  • Reconcile disbursement ledgerserviceBlueprint

How AGI delivers it

Four ways AGI delivers for Claims payment processing or administration

  • 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

Value flow

How Claims payment processing or administration connects

absorbs

  • Benefits Administrationmodel
  • Claims Disbursement Administrationmodel
  • Claims Payment Operationsmodel

measured by

  • Audit Exception Ratemodel
  • Payment Accuracy Ratemodel
  • Payment Cycle Timemodel
  • Payment Error Ratemodel
  • Turnaround Timemodel

optimizes

  • Claims Processing Timemodel
  • Cost Per Claimmodel
  • Disbursement Cycle Timemodel
  • Payment Accuracymodel
  • Payment Accuracy Ratemodel

produces

  • Claims Payment Ledgermodel
  • Explanation Of Benefitsmodel
  • Explanation of Benefitsmodel
  • Payment Disbursement Ledgermodel
  • Payment Registermodel

realizes

  • Adjudicate payment amountmodel
  • Apply deductibles and offsetsmodel
  • Confirm payee banking detailsmodel
  • Disburse claim paymentmodel
  • Issue explanation of benefitsmodel
  • Issue payment noticemodel
  • Receive approved claim filemodel
  • Receive approved settlementmodel
  • Reconcile disbursement ledgermodel
  • Reconcile payment ledgermodel
  • Validate claim against policy termsmodel
  • Validate payee and banking detailmodel

Go deeper

Explore Claims payment processing or administration

Read the deeper take on agi.asView as markdown