ClaimVeritas by AI&S
AI-Assisted Claims Intelligence with Human Oversight
Reduce operational risk, eliminate benefit leakage, and stay audit-ready — without replacing human judgment.
The Business Problem
The Business Problem
Insurance and healthcare claims operations face a consistent set of operational challenges that manual review processes cannot solve at scale.
Benefit Leakage
Manual review misses policy violations and incorrect billing codes, leading to millions in preventable payouts annually.
Slow Review Cycles
Document-intensive claim processing creates bottlenecks. Reviewers spend hours extracting data that should take minutes.
Audit Risk
Without structured decision logs, compliance audits become expensive, time-consuming exercises in reconstruction.
Inconsistent Outcomes
Human-only review produces inconsistent decisions depending on who reviews a claim and when, creating compliance exposure.
The Transformation
Before and After ClaimVeritas
- ×Manual document extraction from claim packages
- ×Reviewer searches policy documents for relevant clauses
- ×Decision rationale captured informally or not at all
- ×Audit trail requires manual reconstruction
- ×Review cycle: 2–5 business days per claim
- Automated extraction of claim fields in seconds
- Policy validation engine surfaces relevant clauses automatically
- Every decision step logged with full reasoning trace
- Audit-ready report generated instantly
- Review cycle: 20–40 minutes per claim
How It Works
How ClaimVeritas Works
Document Ingestion
Claim documents, medical records, and supporting evidence are uploaded and automatically classified.
AI Extraction
Structured data is extracted from unstructured documents — diagnosis codes, billing items, dates, provider details.
Policy Validation
The extraction is validated against policy terms, coverage limits, and applicable compliance rules.
AI Recommendation
ClaimVeritas generates a structured recommendation — approve, flag, or escalate — with full reasoning.
Human Review
A trained reviewer evaluates the recommendation and makes the final decision. AI cannot approve or reject claims autonomously.
Audit Log
The complete decision chain — extraction, validation, recommendation, human decision — is logged and stored.
Human Oversight
Human Oversight is Non-Negotiable
ClaimVeritas is designed as a decision-support system, not a decision-making system. Human reviewers retain complete authority over every claim outcome.
- AI cannot approve or reject any claim autonomously
- All AI recommendations include the full reasoning chain
- Reviewers can override any recommendation with documented rationale
- Complete audit trail captures every human decision
Security & Compliance
Enterprise Security
Private Deployment
Deploy on your private cloud or on-premises infrastructure. Your data never leaves your environment.
Role-Based Access
Granular access controls ensure reviewers only see claims within their authority level.
Audit Trails
Every action — upload, extraction, validation, decision — is logged with timestamp and user identity.
Compliance Ready
Built to support HIPAA, IRDAI, and enterprise data governance requirements.
Getting Started
Pilot in Days, Not Months
ClaimVeritas is designed for rapid deployment. A typical pilot goes live within days of kickoff, not after months of implementation.
Discovery & Configuration
We map your claim types, policy structure, and review workflow.
Integration & Training
System integration with your document management and team training.
Live Pilot
Process real claims with full AI assistance and measurement.
FAQ
Common Questions
Ready to see ClaimVeritas in action?
Request a demo tailored to your specific claim types and policy structure. We will walk through a live workflow with your data model.