AI Claims Examiner

Human expertise meets predictive intelligence

 

AI Claims Examiner is a cloud-based tool that automatically resolves claims suspensions with less administrative oversight. Powered by our flagship AI Cognitive Engine (ACE), Examiner leverages a combination of AI/ML models, predictive business rules, and operational expertise.

Real world results backed by client success 

$1M+

annual cost savings

99.64%

claims approval accuracy

2M+

annual suspensions resolved

Your claims process will never be the same

Manual tasks, disjointed tools, and communication bottlenecks can quickly turn your claims process into a cost center. AI Claims Examiner blends human expertise with predictive intelligence, resulting in a powerful AI assistant that resolves suspensions and flags duplicates with fewer interventions.

All the benefits of cloud-based AI without the risk

Housed in the cloud, AI Claims Examiner reduces financial burden by cutting down staff time spent on manual corrections and endless requests for more information. Examiner features a built-in ethical framework that guarantees no rejection, denial, or adverse decision is ever automated. The result is a faster, secure, and more cost-effective approval process.

Built on our AI Cognitive Engine (ACE)

A unified framework powering multiple AI models 

Advanced AI/ML models

Continuous training using historical claims data

Predictive intelligence

 Pattern recognition and rules-based processing for repeatable tasks

Cloud-native infrastructure

Scalability, accessibility, and integration with existing systems

Introducing the AI Foundry:
Our homegrown innovation engine

AI activation isn’t a check-the-box initiative at enGen. And it’s not something only a few individuals work on in isolation. It’s a cultural pillar that lies at the foundation of everything we do. That’s why we created the AI Foundry—an internal framework responsible for AI development, validation, and implementation.  

 AI Foundry focuses on four core pillars:

1.

Solution and platform transformation

2.

Infrastructure and tooling

3.

Product engineering

4.

Marketing and communications

We intentionally prioritize ethical responsibility over speed-to-market. Our technologists, healthcare experts, clients, and active clinicians work together to strategically develop AI use cases for commercialization and internal transformation.

Find out how enGen can bring the power of AI to your organization.

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Resources

Planning, meeting and team of doctors talking, teamwork and brainstorming healthcare solution or ideas. Listening, speaking and medical professional, nurses or people with clinic or workflow goals

Power Cleaning Claims Operations With enGen’s Automation and AI Tools

When healthcare claims stall due to confusing or incomplete data, members and providers are left waiting. This article explores how enGen’s AI-powered Claims Examiner helps payers accelerate approvals, reduce delays, and unlock measurable cost savings—transforming claims operations from a bottleneck into a strategic advantage.

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From lightbulb to launch: How we built an evergreen AI foundation

All too often we get fixated on the rocket ship but forget about the launching pad. For AI to thrive within an enterprise healthcare environment, the focus needs to be on building the right foundation—one that can handle the whiplash of technological, regulatory, and organizational flux. 

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Planning, meeting and team of doctors talking, teamwork and brainstorming healthcare solution or ideas. Listening, speaking and medical professional, nurses or people with clinic or workflow goals

Implementing AI Responsibly with enGen

In this interview from the 2024 HLTH Conference, our CFO and CTO Mike Stimpson speak with Healthcare IT Today about how enGen is leading the charge in responsible AI implementation. From transparency and trust to real-world impact, the conversation highlights how our approach balances innovation with accountability—ensuring AI is used to solve real problems without compromising on ethics or member experience.

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