Claimwell
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Who it's for

Built for the organizations that carry the claim

Carriers, third-party administrators, and self-insured programs run Claimwell on the same lifecycle, the same guardrails, and the same workbench. What differs is whose strategy is loaded, whose letterhead goes out, and whose system of record is behind the port.

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Group disability carriers

Short-term disability with the full money loop, long-term disability transition with no payment gap, statutory integration where the state has a program, and ERISA clocks that never slip.

What changes on Monday
  • Uncomplicated maternity and whitelisted planned surgeries approve and pay with zero touches
  • Examiners open a queue of decision packages, not a queue of unread mail
  • Leadership changes the straight-through list and sees the effect before publishing
  • Every denial letter carries the regulatory content and an examiner's signature
Where to start: the Mail Room, then File Intelligence, then the Intake agent.

Workers' compensation carriers

Lost-time and medical-only claims with jurisdiction-specific waiting periods and indemnity rates, compensability recommendations that always route to an adjuster, and return-to-work coordination with the employer from day one.

What changes on Monday
  • First reports of injury from employer portals, email, and paper land in one queue
  • Medical bills are routed, not read, by the adjuster
  • Modified-duty inquiries go to the employer before the expected return date
  • State rate tables and waiting periods are data, maintained with an effective date
Where to start: the Mail Room on first reports of injury and medical bills, then File Intelligence.

Third-party administrators

One platform, many clients. Each client gets its own strategy version, its own plan documents, its own letter templates, and its own metrics, on a shared runtime your team operates once.

What changes on Monday
  • Client-specific handoff rules without client-specific code
  • Service-level reporting from the audit store, per client, with no spreadsheet
  • Letters on the client's letterhead with the client's plan cited by page
  • One adapter per client system of record, swapped behind the same port
Where to start: the Mail Room across clients, then one client on the Intake agent.

Self-insured employers and absence programs

Disability, leave, and return to work in one file. Eligibility straight from your HRIS. A concurrent-leave flag so disability and FMLA stay aligned without the platform pretending to adjudicate leave it does not own.

What changes on Monday
  • Census feed drives eligibility; staleness is visible, not silent
  • HR hears from an agent by email with a reference token, not a phone tag
  • Return-to-work planning starts before the expected date, not after it
  • Runs in your own cloud account next to the rest of your HR stack
Where to start: Claim File Intelligence if your documents are already indexed, otherwise the Mail Room.

And for the people inside those organizations

Each role gets a bounded ask and a prepared packet. None of them get a raw file.

Claims examiner

Signs or sends back decision packages. Resolves identity mismatches, unmatched mail, payment exceptions. Makes the calls, with a script.

Nurse consultant

Answers a specific clinical question from a structured summary. Recommends an IME when warranted. Never chases records.

Claims strategy owner

Edits the playbook: segmentation, straight-through rules, cadences, handoff points. Publishes, replays, compares.

Compliance and audit

Reads an append-only store with every constraint check, model call, and signature. Pulls any claim's trail in one query.

Platform and security

Deploys from Terraform into their own account. Owns the GPUs, the network, the secrets, and the model weights.

Lines of business

Start with one line. The platform is already shaped for the next.

Short-term disability is the reference implementation because it has a bounded duration, standardized evidence, and a small decision space. The lifecycle, the control plane, the Mail Room, the evidence layer, and the workbench carry over to every other line unchanged.

Short-term disability

Live reference line. Full money loop, statutory offsets, appeals.

LTD transition

Candidacy, packaging, hand-off, no payment gap.

Workers' compensation

Compensability, indemnity, medical routing, return to work.

Absence and leave

Concurrent-leave tracking today. Leave adjudication is on the roadmap, not in the box.

See the lines of business
Strategy · per client, per lineversioned
client: northwind_group
line: std
version: 2026-11-01.1
straight_through:
  eligible_segments: [simple]
  diagnosis_whitelist:
    - maternity_uncomplicated_vaginal
    - planned_orthopedic_minor
    - hernia_repair # added in .2, replayed
human_in_the_loop:
  approval_beyond_guideline: examiner
  extension_beyond_guideline: nurse_then_examiner
  closure_on_rtw: auto
communications:
  letterhead: northwind
  tone: plain_language

Tell us which claims keep your examiners late

We'll script them as scenarios and run them in front of you, in your cloud, on synthetic data.

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