Processes
Route claims for processing
How route claims for processing are reshaped as AGI capability advances.
ProcessesRoute claims for processing
Business-as-Code
Read as an executable program — the work decomposed into Code, Generative, Agentic, and Human.
Route claims for processing 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 Route claims for processing inherits.
Where Route claims for processing sits
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How the work flows
Trigger: A validated medical or pharmacy claim is transferred from the intake gateway to the core administrative system.
- Ingest validated claim data from the intake system
- Parse claim attributes including provider type, member plan, and diagnosis codes
- Apply routing algorithms to determine processing requirements
- Separate claims requiring medical review, coordination of benefits, or fraud investigation
- Assign the claim to the designated processing queue or automated engine
Outcome: The claim is deposited into the correct automated adjudication engine, specialty queue, or manual examiner workflow.
Measured by
Routing Accuracy RateRouting Cycle TimeAuto-Routing PercentageMisrouted Claim Rate