23% resolved, with the ceiling in sight.
Of the claims the system can see, six in ten resolve without a person. The gap to the ~86% ceiling is data access, not capability: one eligibility endpoint covers a third of all denials, and it is on the client's roadmap.
Fourteen weeks in
- W4Every call answered
- W6Live claim lookup ships
- W10Appeals filed on the line
- W1423% of all calls
- Calls answered1 in 4Every call~3,000 a month
- Claim statusVoicemail, then a callbackRead back in secondsLive API lookup
- AppealsA separate processFiled on the callIDs written to the case
What we maintain
Workflow tuning
Prompts, decision logic, and policy scripts refined weekly from real call reviews; the system gets better because someone is watching.
Endpoint upgrades
As the client's platform team ships new data endpoints, we wire workflows onto them. The eligibility endpoint alone moves a third of denial calls to on-line resolution.
New workflows
A denial-response flow is in UAT now; the email queue, thousands of messages a month handled by half a person, is scoped next.
Operating cadence
Working session with the client's claims and engineering leads; UAT on every workflow change; call reviews.
Deflection trajectory against the ceiling; roadmap re-prioritized by measured call volume and endpoint availability.
Start with a two-week investigation.
Call data in, sized build plan out, and the first workflow takes production traffic within a month.