Health Insurance Claims

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  1. Health Insurance Claims
  2. Use Proto with this system
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Put an AI agent to work in Health Insurance Claims

Prepare policy, claim and payment evidence for the people who decide.

Set it up

  1. Teach your agent ERP.AI

    Load the ERP.AI skill and paste the output into your agent. It explains how to read and update records in your workspace.

    curl -fsSL https://www.erp.ai/skill.md

  2. Give it a role

    Assign the agent its own user and one of the 7 roles. It gets exactly the access that role has, and no more.

  3. Check what it can reach

    Confirm which records, actions and connections the agent can use in your workspace before you point it at real data.

  4. Review its work and usage

    Check the drafts and changes it proposes, and watch its usage receipts as you give it more to do. Agent work uses prepaid credits.

What the agent can do

  • Claims Assessor: List claims awaiting review with their policy and loss dates.
  • Claims Decision Reviewer: Summarize the reported amount, evidence and applicable coverage for a case.
  • Finance Reconciler: Find payment events whose verification state needs a check against the approved benefit.

What stays with a person

  • The insurer's authorized people decide policy issuance, preauthorization and claim benefits.
  • A payment provider confirms paid events.
  • Proto can organize information and help prepare configuration, but those decisions and confirmations remain with their owners.
  • Keep organization scope, reviewer independence and source revisions visible during review.

The insurer's authorized people decide policy issuance, preauthorization and claim benefits. A payment provider confirms paid events. Proto can organize information and help prepare configuration, but those decisions and confirmations remain with their owners. Keep organization scope, reviewer independence and source revisions visible during review.

Set up Health Insurance Claims your way.

Start free, then use Proto to change fields, steps and approvals before your team goes live.

Start now Download Proto

How to get started