Private AI for insurance medical reviewers.

Turn the claim into an organised investigation

Transcribe accounts, classify visible damage and identify inconsistencies or missing evidence for an adjuster.

Inputs: Consented claim calls, damage photographs, policy records and repair estimates.

From observation to completed task

Create the claim worklist, request approved missing items and route specialist reviews.

Prepare a source-linked document inventory

The supporting records include authorised medical report text, review criteria and correspondence.

Qualified reviewers make medical and coverage determinations.

The systems involved

Claims-system access, tested image models, recording consent and role-specific permissions.

SOS AI configures the local models and tool permissions for this workflow. Actions in business software follow the authority you approve; uncertain cases and actions outside those limits go to the responsible person.

What a useful result must get right

An image score is not a coverage decision or proof of fraud; measure overlooked evidence and false referrals.