AI-powered continuous claims review

Audit 100% of claims. Catch compliance gaps, leakage, and reserve issues in real time.

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Trusted by Leaders in Insurance

Up and running in days

Connect your claims system, define a scorecard, and let Adaptional audit every file — continuously. No integration project required.

Connect Claims Data

Feed data from Guidewire, Duck Creek, or any system. Adaptional ingests files, notes, and documents.

Configure Your Audit Guidelines

Define audit criteria that matter — compliance, coverage, reserves, leakage, service quality, and subrogation.

Continuous Audit

Every claim reviewed against your scorecard in real time. Surface issues as they happen, not months later.

Fix Issues While Files Are Open

Send alerts to managers on open files and monitor to ensure issues are resolved

Workflows transformed

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Manual QA wasn't built for this

Teams sample 3-5 files per adjuster per month at <5% of total claims. The rest go unreviewed, and findings come too late to act on.

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Three overlapping cards showing stages of claim processing: Loading Claims with a progress bar, Reviewing Claim with checklist items, and Reviews Complete with total 3,012 and findings by category.

Every hour on QA is an hour not spent on claims

QA requires manual effort: pulling files, filling out scorecards, and writing action plans — all for a handful of reviews that barely scratch the surface.

Random samples miss what matters

Files are randomly selected with little strategic targeting. Many high-risk claims go unreviewed. Patterns across adjusters and teams stay hidden.

Two overlapping document cards with alert icons highlighting 'Unrelated Charges' $5,000 loss cost opportunity and 'Non-Compliant Language' to update MI notice letter.

User interface showing payment activity with $15,200 paid marked as incorrect payout and $12,500 reserved.

By the time you find it, it's too late

By the time a monthly review surfaces a missed deadline or reserve gap, the damage is already done. Leakage compounds every day you don't see it.

Six dimensions. Every file

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Adaptional evaluates every claim across the dimensions that drive leakage, compliance risk, and policyholder outcomes.

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Compliance

Deadlines, regulatory requirements, CMS reporting, time limit demands — flagged before they become violations.

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Coverage

Policy terms matched against claim decisions. Catch coverage errors, missed exclusions, and incorrect limits.

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Leakage

Identify overpayments, missed deductibles, and billing errors that silently erode your loss ratio.

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Service Quality

Contact frequency, documentation standards, and policyholder communication — the metrics that drive retention.

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Subrogation

Surface recovery opportunities buried in claims files. Catch missed subro potential before statutes expire.

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Reserves

Flag stale or inadequate reserves and patterns that signal future development issues.

The real ROI isn't headcount

Even 1% better indemnity accuracy is worth millions. Add reduced leakage, fewer fines, and freed-up manager time — the case builds itself.

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Built by people who know claims — and know AI

Adaptional is building AI for claims — one of insurance's biggest operational blind spots. We combine deep claims expertise with frontier AI. We're SF-based AI engineers and repeat insurtech founders working with some of the largest carriers in the country.

Suril Kantaria

Co-Founder & CEO

Suril was on the early team at xAI and Primer. He was cofounder and CEO of insurance brokerage Savvy (acq. by TakeCommand) and graduated Phi Beta Kappa in Economics & Mathematics from Dartmouth.

Kevin Cox

Co-Founder & CTO

Kevin previously served as Engineering Director at Clipboard Health, where he helped scale the company 10x to $150M+ in revenue and a multi-billion dollar valuation. He was CTO of Savvy and studied Computer Science at Princeton.

See what your sampling misses.

Book a 30-minute call. We'll show you how Adaptional reviews every claim in your book — and what your current QA process is missing.

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