UC-386
Broker Submission Triage & Appetite Fit
Reads each broker submission pack, scores it against the live underwriting appetite and returns a ranked queue with the missing items named.
TBDBuild time
Insurance · Use-Case Library
AI use cases for Insurance
11 reports built for Insurance. Each one shows the challenge, how the agents work, and the value it unlocks - open any report for the full detail.
UC-387
FNOL Triage & Claim Complexity Routing
Reads each loss notification against the policy wording, grades complexity and routes the claim to fast-track, adjuster or investigation.
TBDBuild time
UC-388
Treaty Cession & Recovery Reconciliation
Reads treaty slips and cedent statements, works out what should have been ceded and recovered, and lists every cession that does not agree.
TBDBuild time
UC-389
Claims Fraud Network & Staged-Loss Rings
Links claimants, repairers, medical experts and addresses across claims, scores the networks and surfaces organised rings for investigation.
TBDBuild time
UC-390
Reserving Triangle Movement Explainer
Reads the claim movements behind each reserving triangle, attributes the period change to its causes and drafts the actuarial commentary.
TBDBuild time
UC-391
Delegated Authority Bordereaux Assurance
Checks every coverholder bordereau against the binder terms, scores data quality and flags risks written outside the delegated limits.
TBDBuild time
UC-424
Medical Policy Criteria & Turnaround Clock
Reads each request and attachments, lines evidence up against each medical policy criterion, and hands a pack to the clinical reviewer.
TBDBuild time
UC-425
Network Adequacy and Recruitment Ranking
Tests the provider network against time and distance standards by county and speciality, and ranks which contracts to chase first.
TBDBuild time
UC-426
Risk Adjustment Coding Evidence Integrity
Reads submitted diagnosis codes back against the chart evidence, flags unsupported entries, and packs each case for a certified coder.
TBDBuild time
UC-427
Claim Edit Tuning and Payment Integrity
Reads paid claim lines against the contract, the fee schedule and the edit library, and ranks which recoveries are worth working.
TBDBuild time
UC-428
Member Appeals and Grievance Casework
Reads each appeal and its history, assembles the decision file against the original criterion, and drafts the reply inside the clock.
TBDBuild time