The large majority of medical documents now extract and classify automatically, ending manual keying
Customer story
A regional group benefits carrier
The carrier deployed Smart Claims with document intelligence for medical records and AI triage at intake, list billing reconciled against eligibility on the same fabric, and Customer 360 with complaint workflows and outcome monitoring so service and conduct teams work from one member-level view.
A group disability and health carrier keyed medical records and bills by hand across high claim volumes, adjudication consistency varied by examiner, and eligibility mismatches between enrollment, billing and claims surfaced as member disputes and complaint volume the conduct team could not get ahead of.
Illustrative outcome
92%
of medical documents processed straight-through
- Smart Claims
- Billing & Collections
- Customer 360
Illustrative and capability-framed — representative of platform capability, not a verified named-customer claim.
The challenge
A group disability and health carrier keyed medical records and bills by hand across high claim volumes, adjudication consistency varied by examiner, and eligibility mismatches between enrollment, billing and claims surfaced as member disputes and complaint volume the conduct team could not get ahead of.
The solution
The carrier deployed Smart Claims with document intelligence for medical records and AI triage at intake, list billing reconciled against eligibility on the same fabric, and Customer 360 with complaint workflows and outcome monitoring so service and conduct teams work from one member-level view.
The results
What changed
Illustrative, capability-framed outcomes from the modules deployed — representative of what the platform is built to deliver.
Clean claims straight-through process while complex cases route to examiners with the file prepared
Eligibility, billing and claims reconcile continuously, catching mismatches before they become disputes
Complaints per ten thousand members fell as root causes were tagged and fixed at the source
Our examiners used to be data-entry clerks with clinical judgement. Now the documents read themselves and the judgement is what we pay for.
Modules used
The platform behind the story
Each module deploys independently yet shares the same data fabric, Cortex brain and evidence ledger — explore the ones in this story.
Core Insurance
Smart Claims
Every decision on the file has an author, a rule and a record.
Explore Smart ClaimsCore Insurance
Billing & Collections
Collect every premium, settle every commission, on time.
Explore Billing & CollectionsDistribution & Customer
Customer 360
One view of every policyholder, household and interaction.
Explore Customer 360See these outcomes on your world
Book a working session and we will map your domains, data sources and frameworks onto AegisNow — and show the same story running on your data.