Claimwell Platform · the core

The core every product runs on, and the full lifecycle at the top of the ladder.

One typed port to your system of record. An audit store nothing can edit. A model gateway that keeps your data in your network. A durable workflow runtime for claims that live for weeks. Deployed into your cloud account from Terraform and operated there by a named Claimwell team. The standalone products use a slice of it; the agents use all of it.

See the products Book a demo

Lifecycle

Each state has exactly one owner

The state machine lives in your system of record. Agents drive the transitions through its API. Two products run across every state regardless of which agents are installed: the Mail Room owns inbound items until matched, and Claim File Intelligence owns the file for the life of the claim.

01ReceivedFirst notice from any channel. Claim shell created, claimant matched or created, document attached.Mail Room agent

02Open intakeIdentity and eligibility from HRIS, last day worked from the employer, physician statement from the provider, segment assigned, clock started.Intake agent

03In decisionOwn-occupation evaluation against restrictions and job demands, exclusions checked, duration estimated, straight-through gate applied or recommendation built.Decisioning agent

04PendedSpecific information named, extension notice sent, clock tolled by the clock service. Resumes on receipt or window expiry.Decisioning agent

05Denial recommendedFull adverse-determination package: reason, plan provision, treating-provider discussion, appeal rights, draft letter. Waits for a signature.Examiner · human

06ApprovedBenefit period and payment schedule. Recertification by segment, extensions, return-to-work outreach, employer modified-duty inquiry, suspension on missed recert.Ongoing Management agent

07TransitioningLTD candidacy assessed at the strategy midpoint, package assembled, last STD payment lined up against the LTD elimination period.Transition agent

08Appeal openNew evidence gathered and shared with the claimant before decision. Both-sides analysis routed to a reviewer who was not the original decision maker.Appeals agent · reviewer

09ClosedReturn to work, maximum duration, final denial, withdrawal, LTD transition. Reaching the plan maximum is exhaustion, never a denial.terminal

Workbench

Three queues, one claim file, one strategy editor

The workbench is where humans meet the platform. Each persona sees their queue with decision packages, the claim file with citations that open the page, the action plan the agent is working, and the trace of every step. The strategy owner also gets the editor and the replay.

Examiner queue

Decision packages with sign and send-back. Unmatched mail. Payment exceptions. Prepared calls.

Nurse queue

Referral packets with a specific clinical question. Structured answers go straight back to the requesting agent.

Strategy editor

Form over a versioned document. Publish, apply to open claims at their next decision point, replay, diff, roll back.

Trace view

Every agent step with inputs, outputs, model, and prompt version. Switch the provider and replay side by side.

Claim file · CW-204118 · action planOngoing Management

Objectivereturn to work by Apr 19 Next actionemployer modified-duty inquiry · Apr 9 Open requestrecertification form · due Apr 7 Riskclaimant reported stiffness, wk 4 Last evidence deltaPT note p.2 · significance 0.3 Payments issued4 of 6 · all cleared Strategy version2026-11-01.1 Human touches1 · H5 on day 5

Updated at every agent wake. Rendered to a human at every handoff. Open trace

What each rung uses

Light at the bottom, complete at the top

The standalone products are deliberately light so the first integration is small. The runtime, the constraint checker, and the strategy layer arrive with the first agent, because that is the first time Claimwell is in a loop that leads to a decision.

Core component	Mail Room	File Intelligence	Agents	Full lifecycle
Claims-admin port and write-back adapter	documents, contacts, activities	+ notes, conditions	everything	everything
Audit store, append-only	yes	yes	yes	yes
Document pipeline	yes	yes	yes	yes
Model endpoint	single configured endpoint	single configured endpoint	gateway with task routing	gateway with frontier comparison
Workflow runtime	—	—	yes, one workflow per claim	yes
Constraint checker	—	—	yes, at workflow and adapter	yes
Strategy layer	thresholds config	thresholds config	versioned strategy, read-only editor	editor with replay and diff
Benefit engine and clock service	—	—	from Ongoing Management	yes
Workbench	exception desk	+ examiner panel	+ examiner and nurse queues	+ strategy editor, dashboard
Adapters: HRIS, plan, payments, correspondence, guidelines	—	guidelines optional	as each agent needs	all

Runtime and deployment

Durable by construction, portable by rule

Claims live for weeks. Every model call and tool call is a durable activity, so a crash mid-loop resumes at the last completed step and the history is a complete trace. Cloud-specific code lives in one Terraform module and three thin adapters: object store, secrets, model provider.

Workbench · TypeScript, React

Examiner queue · nurse queue · strategy editor · claim file · trace · dashboard

Platform API · Python

Queues, decisions as signals, strategy service, metrics from the audit store, claim file views

Durable workflow runtime · Temporal, self-hosted

One workflow per claim, one per inbound item. Stages as child workflows. Events as signals. Timers through a world clock so demos run weeks in minutes. Human decisions as signals the guarded transitions wait on.

Model gateway

One OpenAI-compatible endpoint. vLLM on your GPUs by default. Bedrock or Vertex per task class. Every call logged and replayable.

Claims admin adapter

Typed port, Guidewire-shaped. Constraint checker in front. Adapters for ClaimVantage, ClaimCenter, FINEOS, Duck Creek.

System adapters

HRIS census and lookup, plan repository, guidelines, payments, correspondence, LTD intake. Each with a sandbox.

Object store and audit

S3-compatible API everywhere. Append-only audit store that the API cannot edit.

Document pipeline

Render, layout-aware OCR with a vision path for handwriting, classify, extract to schema with field confidence and page citations, validate against the claim.

The world · evaluation harness

Claimant, employer, and provider simulators with realistic imperfections. Scenario scripts with expected outcomes. Accelerated time. Zero constraint violations or the run fails.

AWS · Terraform Google Cloud · Terraform Azure · in progress On-prem Kubernetes · Helm Laptop · docker compose