AGI.do

Services

What will AGI do for Non-medical benefit claims analysis service?

Review of benefit claims for drug prescriptions (and possibly other life/health claims) that were fulfilled where reporting and credits can be obtained. Can be used for ad hoc data analytics.

The work itself

Grounded Work Profile

Tools

  • Claims Management SystemserviceBlueprint
  • Policy Administration SystemserviceBlueprint
  • Document Intelligence PlatformserviceBlueprint
  • Rules EngineserviceBlueprint
  • Fraud Detection Analytics PlatformserviceBlueprint

Outputs

  • Claim Decision RecordserviceBlueprint
  • Adjudication Audit TrailserviceBlueprint
  • Fraud Risk ScorecardserviceBlueprint

Measured by

  • Decision Turnaround TimeserviceBlueprint
  • Adjudication Accuracy RateserviceBlueprint

Key steps

  • Receive benefit claim submissionserviceBlueprint
  • Validate claimant and coverageserviceBlueprint
  • Extract and structure claim dataserviceBlueprint
  • Apply benefit and eligibility rulesserviceBlueprint
  • Flag anomalies and fraud signalsserviceBlueprint
  • Adjudicate and recommend decisionserviceBlueprint
  • Communicate decision to claimantserviceBlueprint

How AGI delivers it

Four ways AGI delivers for Non-medical benefit claims analysis service

  • 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 Non-medical benefit claims analysis service connects

composes

measured by

  • Adjudication Accuracymodel
  • Audit Defect Ratemodel
  • Decision Turnaround Timemodel
  • Determination Accuracy Ratemodel
  • Turnaround Timemodel

optimizes

  • Adjudication Accuracymodel
  • Claim Cycle Timemodel
  • Determination Accuracymodel
  • Fraud Detection Ratemodel

produces

  • Adjudication Audit Trailmodel
  • Claim Analysis Reportmodel
  • Claim Decision Recordmodel
  • Eligibility Determination Recordmodel
  • Fraud Risk Score Datasetmodel
  • Fraud Risk Scorecardmodel

Go deeper

Explore Non-medical benefit claims analysis service

Read the deeper take on agi.asView as markdown