Does this integrate with our core claims system?

Yes—we provide validated adapters for Guidewire, Duck Creek, Applied Epic, and legacy mainframe systems. All integrations are tested during the PoC phase before pilot deployment.

What about security and compliance (FedRAMP, NIST, HIPAA)?

We offer FedRAMP-ready deployment options with NIST 800-53 controls and SOC 2 Type II audit compliance. Solutions support on-prem or air-gapped deployment for sensitive government workloads and meet HIPAA requirements for healthcare-related claims.

How does ClaimVista handle fraud without false positives?

ClaimVista uses tunable scoring with adjuster override capabilities. All flagged claims route to an SIU review queue before denial. Precision/recall metrics are exposed in the KPI dashboard and continuously monitored.

Can we deploy on-premises or air-gapped?

Yes—we support full on-prem deployment for government agencies and GovCloud or commercial cloud options for insurance providers. All data processing and storage can remain within your infrastructure.

What's the ROI timeline for claims automation?

Typical payback occurs within one quarter through reduced loss adjustment expenses (LAE) and faster cycle times. Use our ROI calculator to model savings based on your claim volumes.

How does DocQore handle legacy microfilm and handwritten records?

DocQore uses advanced OCR with human-in-the-loop validation for low-confidence fields. Accuracy is gated before archive ingestion, with quality metrics tracked per batch.

What if our adjusters resist AI-assisted workflows?

ClaimVista augments adjusters rather than replacing them—it pre-fills worksheets so adjusters can focus on judgment calls and customer interaction. Change management support is included in pilot deployment.

AI Solutions for Insurance & Government: Faster Claims, Compliant Documents, Lower Fraud

Built for claims ops, compliance teams, agency it directors

43% faster claims adjudication, 68% document processing lift, and fraud losses down—no core system replacement.

AI-powered claims automation, compliance document validation, and fraud detection for insurance carriers and government agencies. FedRAMP-ready deployments deliver 43% faster claims cycle times and 68% document processing improvements—without replacing core systems.

Quick-win solutions

ClaimVista

Claims automation & adjudication

Auto-triage claims by complexity and fraud signals
Extract policy/loss data from photos and PDFs
Route to adjusters with pre-filled worksheets

What you get:

Claims classifier model with fraud scoring · OCR pipeline for photos and documents · Adjuster dashboard with pre-filled worksheets · Guidewire/Duck Creek adapters

What you get: Claims classifier · OCR pipeline · Dashboard

CompliChek

Compliance document validation

Validate policy docs against state/federal regs
Flag missing disclosures and outdated clauses
Audit trail for SOC 2, HIPAA, FedRAMP

What you get:

Document validation engine · Compliance rules library (configurable) · Audit trail reports · Exception queue workflow

What you get: Compliance engine · Audit dashboard · Export packs

DocQore

Government document processing

OCR + NLP for scanned paper, microfilm, PDFs
PII redaction for public records requests
Searchable archive with metadata tagging

What you get:

OCR engine with handwriting support · PII redaction pipeline (FOIA/PRA-aligned) · Batch processing scheduler · Quality gates and audit logs

What you get: OCR pipeline · Redaction engine · Archive portal

FraudLens

Insurance fraud detection

Anomaly detection on claim patterns and networks
Image forensics for staged accidents
Link to SIU workflows and external databases

What you get:

Fraud detection model with explainability · SIU review console · Override and escalation workflows · Precision/recall KPI dashboard

What you get: Fraud scorer · Investigation queue · API adapters

How it works

PoC

2-4 weeks

Validate feasibility

Pilot

6-8 weeks

Prove ROI on limited scope

Scale

Quarterly

Expand across facility

Products used

ViSTA

Document AI for claims processing and compliance validation

Data & Analytics Platform

Fraud detection models and legacy system integration

Tech & deployment

Claims systems: Guidewire, Duck Creek, Applied Epic via REST/SOAP adapters
Government systems: COTS case management, legacy mainframes via batch/API integration
Security: FedRAMP-ready, NIST 800-53 controls, on-prem or GovCloud deployment options
Privacy: PII masking, configurable retention policies, role-based access, comprehensive audit logs
Infrastructure: Air-gapped deployment for sensitive agencies; commercial cloud for insurance

ROI & proof

43% faster claims cycle time

Large P&C insurer reduced auto claims from 18 days to 10.2 days using ClaimVista for photo triage and data extraction

68% document processing improvement

State agency cleared 14-month FOIA backlog in 90 days with DocQore OCR and redaction pipeline

Methodology

Frequently Asked Questions

Last updated: January 15, 2025

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