Automate health claim decisions from policy and claim context, not rules.
Health claims volume grows faster than the teams that handle them. When every claim needs someone to read the policy, review the evidence and form a view, output is capped by headcount and cost per claim rises with volume. This guide explains how Sprout.ai’s specialist AI agents interpret the policy alongside the claim, recommend the coverage outcome with the clause and evidence behind it, and route only the claims that need a human decision to your adjusters.
What’s inside:
- Why rules engines break down on policy complexity, medical coding and dense clinical evidence
- How Sprout.ai moves from claim data to a recommendation with a confidence score
- Results: up to 80% of claims processed straight through and 67% less adjuster handling time
- The KPIs Sprout.ai moves, from STP rate to cost per claim