AI-powered continuous claims review
Audit 100% of claims. Catch compliance gaps, leakage, and reserve issues in real time.
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Up and running in days
Connect your claims system, define a scorecard, and let Adaptional audit every file — continuously. No integration project required.
Feed data from Guidewire, Duck Creek, or any system. Adaptional ingests files, notes, and documents.
Define audit criteria that matter — compliance, coverage, reserves, leakage, service quality, and subrogation.
Every claim reviewed against your scorecard in real time. Surface issues as they happen, not months later.
Send alerts to managers on open files and monitor to ensure issues are resolved
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.
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.
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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
Adaptional evaluates every claim across the dimensions that drive leakage, compliance risk, and policyholder outcomes.
Compliance
Deadlines, regulatory requirements, CMS reporting, time limit demands — flagged before they become violations.
Coverage
Policy terms matched against claim decisions. Catch coverage errors, missed exclusions, and incorrect limits.
Leakage
Identify overpayments, missed deductibles, and billing errors that silently erode your loss ratio.
Service Quality
Contact frequency, documentation standards, and policyholder communication — the metrics that drive retention.
Subrogation
Surface recovery opportunities buried in claims files. Catch missed subro potential before statutes expire.
Reserves
Flag stale or inadequate reserves and patterns that signal future development issues.
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 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 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.
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