Where teams get stuck.
Claims teams lose time on incomplete files, manual routing, repetitive documentation checks, and reviews that should have been escalated earlier.
Claims triage and decision support
ArqClaims
AI-assisted claims intake, enrichment, routing, and reviewer support.
Overview
Built for healthcare and the teams around them.
ArqClaims turns claims intake into a governed triage flow. It enriches each file, checks it against policy, flags missing evidence, and recommends the next action — while every decision stays with your reviewers and every override is captured.
Built for: Healthcare, insurance, benefits, and claims operations
40%Less manual intake effort
2xFaster routing decisions
100%Reviewer override captured
What changes with ArqClaims.
ArqClaims turns intake into a governed triage flow — enriching the file, identifying missing evidence, recommending next action, and keeping reviewers in control.
Built for production
ArqClaims turns intake into a governed triage flow — enriching the file, identifying missing evidence, recommending next action, and keeping reviewers in control.
Capabilities
What ArqClaims does.
A reusable workflow spine, tuned to your data, systems, and controls — not a generic model wrapper.
Intelligent intake & classification
Reads documents and structured data on arrival, classifies the claim type, and starts the file with the right context attached.
Completeness & evidence checks
Detects missing documents and inconsistencies up front so files don't stall halfway through review.
Policy-aware routing
Applies the right policy checks per claim type and routes to the correct queue or reviewer automatically.
Reviewer copilot
Summarizes the file, surfaces the relevant policy, and recommends a next-best action the reviewer can accept or override.
Override capture & learning
Records every reviewer decision and override to tune routing and evidence prompts over time.
How it rolls out
From fit check to first operating queue.
Accelerators move fastest when the first release is narrow, measurable, and connected to the people who own the work.
01
Map claim types, queues, policy checks, and escalation rules.
02
Connect document, claim, and knowledge sources.
03
Launch triage recommendations beside the existing reviewer process.
04
Tune routing and evidence prompts from reviewer feedback.
Use cases
Where it earns its place.
First-notice-of-loss triage
Classify, enrich, and prioritize new claims the moment they arrive.
Coverage & documentation review
Check files against coverage rules and flag what's missing before a human opens them.
Complex-claim escalation
Spot the files that need senior review early and route them with full context.
Integrations
Wired into the stack you already run.
The accelerator combines claims operating patterns with policy-aware routing, evidence capture, and human-in-the-loop decision support.
Claims & policy admin (Guidewire, Duck Creek)Document & content storesEmail / intake channelsKnowledge basesWorkflow / BPMData warehouse
Fit signals
When ArqClaims is worth a closer look.
- Claims arrive incomplete or misrouted
- Review teams spend too much time summarizing files
- Policy checks differ across teams
- Leaders need cycle-time improvement without losing control
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