How Clive™ AI Works: Multi-Agent Claims Automation
Built on modern, scalable, and secure architecture, designed for claims automation
Claims management is often associated with slow, time-consuming, and error-prone processes. But it doesn’t have to be.
Clive, the insurance industry’s first Multi-Agent AI Claims Expert, is the modern answer to outdated claims processes.
Clive enhances any existing Claims Management System (CMS) with advanced AI and automation, instantly improving efficiency, accuracy, and decision-making. He ensures claims are processed faster, more accurately, and in full compliance—without requiring insurers to overhaul their technology stack.
Clive possesses three core functions that make him the ideal AI partner for insurers, MGAs, TPAs, and reinsurers:
- Compound AI Architecture – Orchestrates end-to-end claims handling, from FNOL to settlement.
- Automation-First Approach – Automates routine and manual tasks for maximum efficiency.
- Robust API Framework – Enables seamless integration with any CMS and third-party providers.
Compound AI Architecture for Claims Management Orchestration
Clive doesn’t just process claims. Unlike traditional claims software that simply records data, Clive combines multiple AI models (compound AI) that orchestrate claims handling with unparalleled speed and automation.
- Natural Language Processing (NLP) - Reads, categorizes, and extracts insights from claims documents, adjuster notes, and communications.
- Machine Learning (ML) - Learns from historical claims data to predict outcomes, flag anomalies, and optimize decision-making.
- Computer Vision - Scans and analyzes images, invoices, and supporting documents to validate claims and detect anomalies or suspicious activity.
- Predictive Analytics - Anticipates claim complexity, recommends the best course of action, and enhances triage accuracy.
Automation-First: AI That Handles the Heavy Lifting
Automation-first means that anything that can be automated, will be. The result is reduced cycle times and claim leakage, nearly zero human errors and happier adjusters and claimants.
Clive automates every step of the claim process, allowing for manual oversight as needed, in line with the insurer’s Standard Operating Procedures (SOPs).
Automated Claim Triage
Analyzes claim severity, assigns the right adjuster, or handles low-complexity claims autonomously.
Coverage & Liability Validation
Cross-checks policies, past claims, and external data sources to determine coverage eligibility instantly.
Reserve Calculation & Adjustment
Automatically calculates reserves based on claim severity, policy coverage, and historical payout data.
Vendor & Payment Automation
Recommends the most suitable vendors, analyzes invoices, and triggers automated payments.
Regulatory Compliance & SOP Adherence
Ensures every claim follows standardized workflows, compliance rules, and audit requirements.
Proactive Decision Support
Suggests the next best action, helping adjusters make data-based and faster decisions.
Auto Generated Comms
Drafts policyholder updates, adjuster reports, and legal notices in real time, reducing administrative work.
Anomaly Detection
Uses AI to flag suspicious claims based on historical patterns, external data, and behavioral analysis.
Subrogation Identification
Identifies opportunities for subrogation and flags relevant claims for further investigation.
Claim Documentation & Categorization
Automatically extracts key details from documents, emails, and images, organizing them for easy access.
Automation Improves Claims Operations
These figures reflect real-world improvements our insurers achieve with Clive
API Framework: Plug & Play with Any System
Clive’s solid API framework allows seamless integration with any CMS, policy admin system, payment processor, or third-party data provider.
Clive integrates with medical billing databases, vendor networks, and compliance systems, ensuring a smooth, interconnected claims process.
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