Claimwell takes over claims work one rung at a time, inside your system of record and your cloud. Start by indexing every document the day it arrives. Grow to agents that run each stage with your examiners signing every decision that matters.
Runs inside your perimeter. Never makes an adverse decision.
Most "AI for claims" is a copilot bolted onto an examiner's screen. Claimwell is the examiner's team: agents that own the file, chase the evidence, calculate the benefit, and hand you a decision package when a human is required.
Every lifecycle stage has one owner. Agents arrive one at a time, in a fixed order, and run their stage. Examiners get decision packages, not alerts.
Standalone products never enter the loop. In the platform, denials, terminations, reductions, appeals, and banking changes are blocked in code until an examiner signs.
Deploys into your AWS, GCP, or Azure account with Terraform. Open-weight models run on your GPUs. Frontier models are an opt-in route, never the default.
Agents are integrators. They work through one claims-admin port with adapters for Guidewire, ClaimVantage, FINEOS, and your HRIS, payment, and correspondence systems.
Each write carries a rationale and page-level evidence citations. Every model call is logged with its prompt version and can be replayed against a different model.
ERISA deadlines, statutory offsets, elimination periods, and benefit math come from rule engines, never from a model. The explanation is printed with every number.
Claims and documents arrive the way they really do: scanned mail, fax, email, portal uploads, employer feeds, call notes. The Mail Room agent classifies, matches, and routes each item. The Evidence agent keeps the file reconciled for the life of the claim.
Every channel, one queue. Duplicate faxes, cover sheets, and junk mail are discarded with an audit record. Ambiguous matches go to a human.
Layout-aware OCR with a vision model for handwriting and degraded scans. Every field carries a confidence and a page citation.
When an orthopedic report lands at week nine, the owning agent wakes to a summary of what changed, what conflicts, and what it implies.
Identity, active-at-work status, hours, and coverage are verified against the HRIS census feed, with staleness visible.
Cardinal rules are enforced in code and can't be relaxed by anyone. Your claims strategy is a versioned playbook your leadership edits without engineers. Agent judgment lives inside the room those two leave open.
No denial without a signature. No payment outside an approved period. No letter stating a decision that isn't on record. Checked at the workflow and at the write.
Segmentation, straight-through whitelist, contact cadence, clinical triggers, and sixteen named handoff points. Publish a version, replay last quarter, diff the result.
When a human point is reached, the examiner gets the recommendation, the rationale, the cited evidence, and the draft letter. Sign it or send it back.
Clinical referrals, duration beyond guideline, and extensions route to the right persona with a prepared packet and a bounded ask.
After approval the work isn't over. The Ongoing Management agent pays on schedule, requests recertification by segment, reaches out before the expected return-to-work date, asks the employer about modified duty, and flags long-term disability candidates early so nobody falls into a gap.
Days from first notice to approval, pend, or recommendation. Cut by segment, cause, channel, and strategy version.
Paid duration versus optimal and maximum for the diagnosis and job class, as a distribution you can act on.
Counted by handoff point and persona, so you can see exactly where your examiners' time goes and move the dial.
Change one setting, replay last month's claims under the new version, and compare the metrics before you publish.
Each has a queue, a workbench, and a bounded ask. Nobody reads a raw file. Nobody re-keys a date.
Opens the queue to find a denial package with the reason, the plan section, the cited pages, and the draft letter. Signs it, sends it back, or picks up the phone with a prepared script. Never writes a clock date by hand.
Receives a referral packet: structured clinical summary, restrictions against job demands, duration against guideline, and the specific question being asked. Answers it, recommends an IME if warranted, and the claim moves on.
Widens the straight-through whitelist to include hernia repair, lowers the duration tolerance by five points, replays last quarter, and sees the change in touches and cycle time before publishing the next version. No ticket, no sprint.
Claimwell is sold as a ladder, not a monolith. Two products stand alone and never touch a decision. The agents come after, one at a time, in a fixed order. The Harness proves all of it before go-live.
Every inbound document captured, matched, labeled, and written into your claims system with the provider, service dates, and codes filled in. Replaces manual indexing.
A file that knows what it contains, what changed since the examiner last looked, and where it says so. Annotates, never decides.
Intake, Ongoing Management, Decisioning, Transition and Appeals. Each does a stage's work and hands your examiner a package to sign or send back.
Simulated claimants, employers, and providers with realistic imperfections. Run your hardest claims through any change before it touches a real one.
Claimwell ships as a deployable package: container images, a Terraform module per cloud, a Helm chart, a runbook, and an evaluation harness. Your platform team runs it in your account. We never hold your data.
Served with vLLM in your VPC. Model traffic never leaves your network. Swap models with a config change.
Route any task class to Amazon Bedrock or Vertex AI through the same gateway. Compare outputs side by side in the trace view.
Every managed service has an open equivalent in the compose stack. Cloud-specific code lives in one Terraform module and three thin adapters.
Append-only. Every constraint check, every model call, every human signature, with prompt and strategy versions attached.
Read the deploy and security page
The lifecycle, the control plane, and the evidence layer are shared. Each line brings its own stages, rules, and handoff points. Who it's for
Fully insured STD with the complete money loop: eligibility, elimination period, benefit, statutory offsets, payments, recertification, extensions, closure.
A Transition agent assesses candidacy at the strategy's midpoint, gathers the LTD claim form and fresh physician statement, packages the file, and lines up the last STD payment against the LTD elimination period.
Same Mail Room, same evidence layer, same examiner workbench. Jurisdiction-specific indemnity rules, compensability, medical bill routing, and return-to-work coordination with the employer.
Bring a plan document and a scenario you find hard. We'll run it under accelerated time and show you where the agent stops and the examiner starts.
Synthetic-data sandbox available on request. No claimant data required to evaluate.