Claims Compliance Audit demo
Every closed claim checked against the fair claims rules for its state, each step dated from the file. 1:13
What the demo shows
A claims audit solution that checks every closed claim against its state fair claims rules.
Each closed claim becomes a strip of its state's five fair claims steps (acknowledge, investigate, decide, pay, explain a denial), each a dot on time or late against the dates in the file. Six agents read each file, test each step and price each late one from the state's penalty basis, so the fix plan ranks root causes by money at risk. A reviewer confirms each exception; the exam pack builder assembles the evidence, cited to the file page and the rule.
Transcript
- Claims Compliance Audit checks every closed claim against its state's fair claims rules.
- Reviewers sample 60 files a quarter.
- Examiners test them all.
- Overnight, six agents read every claim closed in the quarter.
- Each claim becomes a strip of five steps, each dot on time or late.
- One read that the Prescott's claim decided nine days past California's 40.
- That late step carries a $5,000 exposure, cited to the code.
- Ranked by money, California status letters come first, $315,000.
- LENA confirms, and the exam pack builds itself, every file cited.
- Every closed claim checked, not the few dozen a reviewer can sample.
- Built on Botminds: agents, data, screens, and governance on one platform.
Transcribed from the film’s narration. Captions are on the player.