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AI Engineering for TPA & Claims Operations

We automate claims processing at scale, SLA tracking, and multi-client reporting — your adjusters investigate, not type.

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What We Automate

We don't know every problem in your operation. You do. These are the types of work we engineer AI for. You tell us where it hurts most.

Data Entry Automation

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Your team re-types data from one system to another. We eliminate that.

claim forms medical records police reports adjuster notes

Incoming Request Processing

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Requests come in from everywhere in every format. We read, classify, and route them.

FNOL intake claimant correspondence subrogation demands vendor invoices

Billing, Payments & Reconciliation

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Your finance team spends days matching payments across clients. We do it in minutes.

reserve reconciliation indemnity payments fee schedules client billing

Report & Dashboard Consolidation

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Every client wants reports in a different format. Your team builds them by hand. We automate it.

loss runs SLA scorecards claims bordereaux stewardship reports

Compliance & Audit Readiness

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Every audit is a fire drill. We keep you ready all the time.

adjuster licensing claims handling compliance state regulations client SLA audits

Risk Detection

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Patterns hiding in your data that your team can't catch at scale. AI finds them.

fraud indicators litigation risk reserve adequacy severity trends
See How We Work →
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Common Questions About AI for TPAs

How do we start?
We start with a 2-week AI Roadmap. Our engineers spend time inside your operation — watching how claims flow across clients, where SLAs slip, how reporting gets assembled. The output is a ranked list of workflows by ROI, with implementation timelines and expected savings. No commitment to build beyond the roadmap.
What does my team do differently on day 1?
Almost nothing. The first workflow runs alongside your existing process — AI processes claims or reports in parallel while your team works normally. Once accuracy is validated (typically 2-3 weeks), we switch over. Your adjusters focus on complex claims instead of data entry. The transition is gradual, not a big bang.
How do you handle multi-client configurations?
Every TPA operates differently per client — different SLAs, different reporting formats, different adjudication rules. We build configurable workflows that adapt per client without rebuilding. One AI engine, multiple client configurations. Your team manages client relationships. We manage the automation behind them.
Can you integrate with our claims management system?
We build on top of your existing systems. We integrate with every major claims platform — Guidewire, Origami Risk, ClaimVantage, and custom-built systems. The AI layer connects your claims system to client portals, document management, and reporting tools. No system replacement needed.
How do we measure success?
We define success metrics with you before building anything. Typical metrics: claims cycle time, SLA compliance rate, cost per claim, auto-adjudication rate, and reporting turnaround. We set up dashboards that show before/after in real-time per client. If the numbers don't improve within 90 days, we fix it on our dime.
What's the total cost for year 1?
Two options. Per Workflow: $25K-$75K per workflow, best for starting with one high-impact process like FNOL intake or SLA reporting. Dedicated Team: ~$22K/month for 2+ AI engineers embedded in your operation, building multiple workflows continuously. Most TPAs start with one workflow, prove the ROI, then move to a dedicated team.

Scale your claims volume without scaling your headcount.

Book a free 30-minute AI Assessment. We'll map your highest-volume workflows and show you the 3 processes with the highest ROI.

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