Case 2:

AI-Driven Claims Adjudication

Client
National benefits administrator processing employer-sponsored health, FSA, and HRA claims.

Challenge
Manual claims adjudication created processing bottlenecks, high staffing costs, and inconsistent turnaround times.

AI Infusion™
AI Solution

We implemented an AI-assisted adjudication system that:

  • Uses OCR to extract data from receipts and supporting documents
  • Cross-references expenses against claim details
  • Validates eligible expenses using IRS guidelines
  • Automatically approves low-risk claims
  • Flags exceptions with clear error indicators for human review

As a result, human reviewers focus only on genuinely complex cases.

Business Impact

  • 80% of claims automatically approved by AI
  • 3× increase in average claim processing speed
  • 55% reduction in back-office staffing
  • $1.2 million in annual cost savings

Value Delivered
Massive gains in throughput and efficiency while improving reviewer accuracy and reducing operational strain.

Back
A young professional white woman with glasses, focused intently on a futuristic computer monitor displaying AI data and analytics. She is sitting in a modern office environment with sleek furniture and soft lighting, emphasizing a high-tech yet inviting atmosphere. The monitor should show vibrant graphics and information, illustrating advanced AI technology. The composition should be simple and clear, with the woman as the main subject, showcasing her engagement with the technology.