01 / Extract
Build the claims record
Extract patient, provider, policy, and clinical details from claim forms and supporting documents. Validate and normalize the information for downstream evaluation.
Insurance Claims Processing
From submission to an explainable decision.
Bring claims documents, medical context, and policy rules into one intelligent workflow. insors helps claims teams reduce manual effort and reach consistent outcomes with evidence behind every assessment.
- Less manual processing
- Consistent rule application
- Traceable decisions
The claims workflow
From documents to assessment.
Each stage builds on the same claims record.
02 / Correlate
Understand the clinical story
Map clinical information to standardized medical codes. Check treatments, procedures, medications, and tests against the diagnosis and relevant history.
03 / Evaluate
Put policy rules to work
Interpret structured policy data and unstructured policy documents. Apply coverage, eligibility, exclusions, waiting periods, and limits to the claim.
04 / Explain
Make outcomes traceable
Produce a claim outcome and calculate payable amounts where applicable. Tie findings to the policy conditions and clinical context behind the assessment.
Capabilities
Read the whole claim in context.
Document understanding
Read claim forms, receipts, medical records, prescriptions, and bills. Connect patient, provider, treatment, and amount details in a structured record.
Medical intelligence
Normalize diagnosis, procedure, medication, and laboratory information. Consider patient history and flag clinical mismatches or missing information.
Policy evaluation
Apply coverage, eligibility, waiting periods, exclusions, and limits from policy data or documents. Calculate payable amounts where applicable.
Explainable adjudication
A clear outcome. A visible reason.
Give claims teams a traceable decision record for resolution, downstream review, and audit.
Approved
Policy conditions met
Show the applicable rules and evidence supporting approval.
Partially approved
Adjustments explained
Clarify the covered amount and the reasons for any adjustment.
Denied
Reasons made explicit
Connect the outcome to relevant policy conditions and claim findings.
Further review
Exceptions in context
Surface missing information or potential mismatches for assessment.
Talk to insors
Start with your workflow.
Tell us where the manual work adds up. Let’s explore how insors can help.