Perform research and resolve inquiries
How perform research and resolve inquiries are reshaped as AGI capability advances.
Business-as-Code
Read as an executable program — the work decomposed into Code, Generative, Agentic, and Human.
Perform research and resolve inquiries sits inside a larger value-flow — 1 parent structure it composes into. The hierarchy is grounding, not the story: it tells you which aggregate exposure Perform research and resolve inquiries inherits.
Where Perform research and resolve inquiries sits
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How the work flows
Trigger: A member, provider, or broker submits a complex question, grievance, or appeal that requires escalation beyond tier-one support.
- Log and classify the escalated inquiry or appeal
- Assign the case to a dedicated research specialist
- Extract policy terms, medical records, and historical claims data
- Evaluate the collected data against coverage guidelines and state regulations
- Determine the appropriate resolution or claims adjustment
- Update the policy administration and claims systems
- Draft and send the final determination notice to the stakeholder
Outcome: The inquiry is investigated, a definitive resolution is applied to the account, and the stakeholder is notified of the outcome.