Reviewers, collaboration, and controls

Human-led workflow

More reviewers should create better checks—not more confusion

Every reviewer has a clear role, and every conclusion remains connected to the claim, processing run, source page, and review outcome.

Different reviewers, different jobs

AI 1

Find

Reads the claim and proposes issues with supporting evidence.

AI 2

Challenge

Checks completeness, questions weak evidence, or compares policy logic.

Adjuster

Decide

Confirms or rejects the issue and records professional judgment.

Lead

Approve

Reviews exceptions, disagreements, and high-severity outcomes.

The current application provides the shared claim library, immutable processing history, violation-level ratings, decisions, and comments. Multiple specialized AI-review stages and formal claim-level approval routing are the next evolution of the workflow—not features that should be assumed without implementation and validation.

Checks that should stay visible

  • Evidence: Which page supports the finding?

  • Version: Which model and review instructions produced it?

  • Disagreement: Did another reviewer reach a different conclusion?

  • Human decision: Who confirmed or rejected the issue, and why?

  • History: Is this the current run or an older comparison?

  • Outcome quality: Which violation types are frequently rejected?

Accuracy before scale

Before using the tool during a large event, teams should test it on known claims and measure:

  • issue-level precision and recall;

  • agreement with experienced adjusters;

  • false positives by violation type;

  • processing failures and incomplete files;

  • reviewer time per claim; and

  • differences across model and instruction versions.

Low-confidence findings and reviewer disagreements should be routed for added human attention. The safest workflow uses automation to focus expertise—not to hide uncertainty.

Warning

Final coverage, adjustment, and approval decisions remain with authorized insurance professionals operating under the carrier’s procedures and applicable requirements.