RecommendedClaims reads every medical record, note, and bill the moment it lands. Your adjusters get a grounded, cited recommendation instead of a black box score.
Adjuster caseloads keep climbing while medical records, billing lines, and notes pile up in formats nobody has time to fully read.
A single long tail claim can carry hundreds of medical records across dozens of providers, and most of them never get read end to end.
Without a duration signal, claims quietly drift past the point where early action would have mattered.
High-attrition front-line examiners are asked to make judgment calls that used to require years of tenure.
Litigation, mental-health, and comorbidity signals sit buried in free text until a claim is already in crisis.
Claim data, scanned documents, and guidance tools live in disconnected silos, so nothing lines up at the point of decision.
Leaders find out where a claim went wrong in a quarterly review, long after there was still time to change course.
We ingest what carriers already have, extract the facts with citations, and generate next best action guidance that adjusters can trust. Everything happens inside their existing workflow.
We accept any client feed format and map it to one canonical claim model with no manual re-entry.
Every fact pulled from a document keeps its source page and quote.
Explainable models produce a score and a range, never an opaque number.
Guidance lands in the worklist, ready to accept, reject, or snooze.
Three product lines run on one shared platform. Each line of business is configured, not rebuilt.
Guidance across short term, long term, and individual disability claims. Duration is always expressed as a range instead of a single date, change in definition is tracked, and every next best action is cited to the source note.
Return-to-work ladder tracking, litigation and escalation signals, and specialist-referral timing across the full life of an indemnity and medical claim.
Every scanned record, note, and bill is distilled into a cited claim summary, timeline, and chat. Reviewers get the medical picture without reading the whole file.
Every claim moves through the same transparent pipeline. You can see the full architecture on the Platform page.
Deliveries land encrypted, are deduplicated by content hash, and are mapped into one canonical claim record with no manual re-entry.
Scanned records are read at scale and turned into structured, individually cited facts such as diagnoses, procedures, providers, and restrictions.
Transparent scoring models and grounded language models turn those facts into an impact score, a duration range, and next-best-actions.
Guidance lands in the worklist with full citations. Adjusters can accept, reject, or snooze with a reason, and every action is auditable.
These figures are illustrative benchmarks for AI guided claims programs. This site is a proof of concept and does not report results for any real customer.
Claim files carry PII and PHI by definition. RecommendedClaims is built around encryption, isolation, and an audit trail from day one.