Claims Adjudication
Full claim file ingested -- FNOL, medical records, repair estimates, policy declarations. Evaluated against coverage terms, exclusions, sub-limits. Simple claims end-to-end. Complex claims routed with analysis complete.
Industries
AI Agents for Insurance
MightyBot automates insurance claims adjudication, medical necessity review, and policy evaluation. State-by-state compliance. Evidence pointers for every decision. 99%+ accuracy.
Why MightyBot
MightyBot automates the insurance workflows where errors have legal consequences and "good enough" gets you sued. Claims adjudication, coverage verification, medical necessity review -- executed end-to-end with evidence pointers for every decision. State-by-state compliance as first-class rules. 99%+ accuracy. SOC 2 Type II certified.
The Workflows No One Else Can Solve
This is not claims triage. These are real insurance decisions made with the full policy, supporting evidence, and regulatory context in view.
Medical Necessity Review
Clinical documentation cross-referenced against coverage terms, evidence-based guidelines, and state mandates. Structured determinations with citations. Cases exceeding thresholds route to clinical staff with preliminary analysis complete.
State-by-State Compliance
50 states. Hundreds of distinct requirements. All managed as enforceable policies. When regulations change, policies update in plain English. Policy to production. Same day.
Document Intelligence
EOBs, medical records, police reports, repair estimates -- dozens of document types classified, extracted, and indexed automatically.
How MightyBot
Executes
The Integration Is the Product
Operates inside your claims management platform and policy administration system. End-to-end execution. No rip-and-replace.
Edge Cases Handled
Not ignored. Not queued indefinitely. Confidence thresholds route uncertain decisions to reviewers with full context. Every decision includes a why-trail.
Parallel Policy Evaluation
Coverage, liability, compliance analyzed simultaneously. Execution plans that run at 10x speed.
Production Results
They solve easy workflows. We solve hard ones.
Use Cases
Claims Processing & Adjudication
End-to-end evaluation with citations
Medical Necessity Review
Clinical documentation against coverage criteria
Intelligent Document Processing
Classification across every insurance document type
Policy Evaluation & Enforcement
Carrier, state, and regulatory rules enforced
Compliance Monitoring & Reporting
Continuous compliance. Audit-ready exports
See claims adjudication in production.
Real claims, real policies, real compliance. Not a demo. In production.
Request a demoFAQ
Frequently Asked Questions
How does MightyBot handle state-by-state regulatory variation?
Each state's requirements are individual policies in plain English — timely filing, mandatory disclosures, claim handling standards. When regulations update, policies change without code. Every claim evaluated against applicable state requirements.
Can MightyBot process medical records for necessity review?
Medical records in all formats — PDFs, scans, digital health records. Diagnoses, procedures, and findings extracted and mapped against criteria and coverage terms. Cases exceeding thresholds route to clinical reviewers with analysis complete.
How does MightyBot ensure fair claims handling?
Every decision includes a why-trail — policies evaluated, data referenced, reasoning chain. Available to claimants, adjusters, compliance, and regulators. Same policies applied consistently. No variability.
What happens with edge cases?
Edge cases handled. Confidence thresholds route uncertain decisions to qualified reviewers with full context and specific escalation reasons. Reviewers decide in minutes, not hours.
How does MightyBot handle NAIC compliance?
NAIC model laws and state implementations are enforceable rules in the policy library. Market conduct standards, unfair claims practices, prompt pay statutes evaluated automatically. Audit exports formatted for regulatory examination.
What lines of business does MightyBot support?
Any line governed by documented rules — property, casualty, health, workers' comp, specialty. Policies customized per carrier and line. New lines added by defining policies in plain English.