Enhance Claims Auditing and Quality Assurance

Auditing closed claim files to ensure adherence to procedures, accurate payments, and identification of leakage (overpayments or missed recoveries) is vital but often limited to small samples due to manual effort. LLMs can automatically review large volumes of closed claims, comparing actions taken against best practices, policy terms, and regulatory requirements. They can identify deviations, potential leakage, and areas for process improvement much more comprehensively than manual audits.