I
Connect policy & data
Integrate enterprise systems and ingest policies, rules, and historical decisions into the decision engine.
Starting with insurance claims
Decision infrastructure for regulated workflows
Turn expert judgment into consistent, explainable, auditable decisions.
40%Faster claim handlingINSURANCEPilot design target
85%Decision accuracyINSURANCEPilot design target
60%Faster prior auth cyclesHEALTHCAREPilot design target
5×Faster exception triageLOGISTICSPilot design target
40%Faster claim handlingINSURANCEPilot design target
85%Decision accuracyINSURANCEPilot design target
60%Faster prior auth cyclesHEALTHCAREPilot design target
5×Faster exception triageLOGISTICSPilot design target
Pilot design target. Derived from workflow benchmarking and expert-reviewed datasets. Verify in your 90-day pilot.
“The bottleneck is judgment, not document intake.”
Regulated teams do not need another document parser. They need consistent expert-level decisions with audit trails your regulators can trust.
Where we start
Claims decision workflows, built for production
Start with claims review and expert escalation. Then automate repeatable triage, coverage, and subrogation — with audit-ready reasoning on every call.
Claims Triage
Prioritize complexity, severity, and expertise required. Route to the right adjuster from day one.
Coverage Reasoning
Match policy language to claim facts with cited provisions on every coverage decision.
Subrogation Detection
Surface third-party liability and recovery signals early — before opportunities are missed.
Proof
Built to be verified in production
We do not ask you to trust headline numbers. We ask you to verify them in a structured pilot.
90-day pilot framework
Structured before/after measurement with agreed KPIs, baseline capture, and anonymized results.
View pilot programExplainability stack
Six-layer audit architecture — policy citations, rationale, and human override on every decision.
See proof stackBenchmarking methodology
How regulated teams measure decision quality, accuracy, and cycle time in production pilots.
View measurement approachDesign partner program
Verify outcomes on your claims stack — not ours
IntelliHuman is an early-stage company. We do not publish customer case studies yet. Instead, we work with a small number of design partners on structured 90-day claims pilots — measured against your baselines, on your Guidewire or Duck Creek environment.
Accepting a limited number of claims design partners for 2026.
What design partners get
Structured 90-day pilot
Agreed KPIs, baseline capture, and before/after measurement — no long-term contract required.
Roadmap influence
Early partners shape triage, coverage, and subrogation workflows for production claims operations.
Co-publication option
If the pilot succeeds, anonymized outcomes may be published — only with your explicit permission.
Preferred commercial terms
Design partners receive favorable pricing if you expand after a verified pilot.
What we look for
- 500+ claims per month in the target workflow (triage, coverage, or subrogation)
- Guidewire, Duck Creek, or other digital CMS with API access
- Executive sponsor and claims operations stakeholder
- Willingness to share anonymized before/after metrics
The real bottleneck
Automation vs judgment
Automation handles intake. The hard part is judgment — and that is where regulated teams lose time, money, and trust.
60%
Expert time wasted
Senior staff still triage work automation should handle — but cannot replace judgment.
1×
One mistake, real liability
A single unexplainable decision can mean fines, churn, or litigation.
→
Knowledge walks out
Decades of expertise vanish when adjusters and underwriters retire or leave.
Automation alone
Faster intake.Same judgment gaps.
- Document intake and RPA — no policy context or judgment
- Black-box outputs auditors and regulators cannot trust
- Months of fine-tuning, still fragile on edge cases
Decision infrastructure
Expert judgment.Consistent and auditable.
- Expert judgment encoded as consistent, auditable decisions
- Policy citations and rationale on every recommendation
- Overlay on Guidewire, Duck Creek, and your existing CMS
Curious about our technology approach? See how decision infrastructure works.
Decision workflows
Decision workflows for regulated industries
Production decision paths for claims, prior authorization, and logistics — each built from real expert knowledge.
Pilot design targets — derived from benchmarking against historical claims workflows and expert-reviewed decision datasets. 90-day pilot framework and benchmarking methodology.
What is a decision workflow?
A regulated decision pathwith experts built in.
Each workflow targets a high-stakes decision — claims triage, prior auth, logistics exceptions — with policy-native reasoning, SME validation, and KPIs you can measure in a structured pilot.
Start with claims in a pilot, then expand across business units when outcomes are verified.
Core capabilities
Designed for high-stakes decisions
Decision infrastructure capabilities tuned for regulated, high-stakes deployments.
01
Policy-Native Reasoning
Rules, policies, and regulatory logic are first-class inputs, so decisions stay aligned with operational and compliance expectations.
02
Audit-Ready Decisions
Every recommendation is traceable with rationale, source context, and execution history for legal, risk, and quality reviews.
03
Expert-in-the-Loop
Subject matter experts can validate outputs, encode nuance, and continuously refine decision policies without rebuilding systems.
04
Exception Handling
Edge cases are routed with context and confidence signals so teams can resolve exceptions faster without workflow breakage.
How it works
Three steps to production
From expert knowledge to production-ready decision workflows in three steps.
II
Encode SME knowledge
Subject Matter Experts validate domain playbooks, edge cases, and reasoning patterns through the SME Portal.
III
Deploy decision workflows
Production workflows go live with audit trails, human-in-the-loop controls, and measurable KPIs verified in pilot.
API example
POST /v1/workflows/claims/triage
{
"claim_id": "CLM-2026-8841",
"policy_refs": ["§4.2", "§7.1"],
"loss_payload": {
"type": "collision",
"severity": "moderate"
},
"mode": "audit-ready"
}
// response
{
"priority": "high",
"route_to": "senior_adjuster",
"confidence": 0.91,
"reasoning_trace_id": "trace_78f2aa",
"requires_human_review": false
}Outcomes
KPI outcomes teams can verify
Pilot design targets teams can verify — not fabricated customer attributions.
Pilot design targets — derived from benchmarking against historical claims workflows and expert-reviewed decision datasets. 90-day pilot framework and benchmarking methodology.
Claims Adjudication Quality
85%
Decision Accuracy
“Policy-linked rationale and expert feedback loops improve consistency across high-volume adjudication queues.”
Pilot design targetView workflowPrior Auth Turnaround
60%
Faster Cycle Time
“Teams reduce manual review load by routing standard approvals and escalating exceptions with full context.”
Pilot design targetView workflowException Operations
70%
Faster Resolution
“Exception-heavy workflows recover faster with triage logic that surfaces next-best actions instantly.”
Pilot design targetView workflowIntegrations
Works with your enterprise stack
An overlay on Guidewire, Duck Creek, and your existing CMS — not a replacement. Connect IntelliHuman to the systems your teams already run.
EpicCernerGuidewireServiceNowSalesforceOracleREST API
SAPWorkdaySnowflakeFHIRHL7EDI X12Databricks
Trust & Security
Security architecture for regulated operations
Compliance-first section pattern with certification badges and platform controls.
SOC 2
HIPAA
GDPR
ISO 27001
CCPA
HITRUST-ready
Enterprise Security
Encryption in transit and at rest, environment isolation, and policy-level access controls.
Full Audit Trails
Every recommendation includes rationale traces, policy references, and reviewer-ready logs.
Policy Compliance
Policy-native decisioning aligns outputs to domain standards and internal governance controls.
Data Sovereignty
Deploy in your environment with strict data residency boundaries and SME IP protection.
FAQ
Frequently asked questions
How claims decision infrastructure works, how it fits your stack, and what to expect working with us as an early-stage company.
Start with claims
Ready to verify decision infrastructure in your claims operation?
Start a 90-day pilot on claims triage, coverage reasoning, or subrogation — with measurable KPIs and full audit trails from day one.