SolutionsInsuranceClaims Exception Review
by HumanAgent

Claims Exception Review

AI processes routine claims. Human reviews edge cases that don’t fit standard rules.

Typical budget · $15–$75 per claim

Volume and enterprise pricing available · you set the budget per task

The problem

Your claims AI handles the routine 80% automatically. But the remaining 20% — unusual damage patterns, policy interpretation edge cases, late filings with legitimate reasons — sit in a queue costing you SLA penalties and customer trust.

How it works

01

Submit your insurance claim

Via form, API, or SDK. From any workflow or AI agent.

02

AI analyzes and flags

AI processes routine claims automatically, flags exceptions that need human judgment

03

Human reviews what matters

Credentialed professional (adjuster-certified preferred) reviews flagged items within your SLA. Credential requirements vary by task.

04

Result + audit trail

Structured decision. SHA-256 audit hash. Tamper-proof record.

What the human reviewer does

Reviews claim details against policy terms and coverage limits

Assesses whether edge-case circumstances warrant exception handling

Checks documentation completeness (photos, reports, third-party data)

Makes a coverage determination: approve, deny, or request more info

Documents reasoning for audit trail and regulatory compliance

Pricing

Typical budget · $15–$75 per claim
  • You set the budget per task — operators choose what to accept
  • Volume pricing for recurring workflows
  • Enterprise agreements for committed volume
  • Operators earn 80% of the checkpoint budget
  • Auto-refund if the deadline is missed

Who reviews

Verified professionals matched to the Insurance category

Credential requirements vary — some tasks require specific certifications, others are open to all verified operators

Every review includes a SHA-256 audit hash for verification

Preferred credential for this use case: Credentialed professional (adjuster-certified preferred)

Built with HumanAgent

This use case was built with the HumanAgent API. You can build your own version — customize the workflow, set your own pricing, integrate your own AI, and choose your operators.

Operator credential requirements vary by task. Some tasks are open to all verified operators.