Claims
Klevera Claims Intelligence
Triage claims automatically, detect anomalies, and route complex cases to the right reviewers with full provenance behind every action.
Capabilities
- Automated claims triage
- Anomaly detection
- Payment integrity
- Auditable decision trails
- Reviewer workload routing
- Policy-version aware adjudication support
Triage at intake
Claims are classified, enriched from the Knowledge Fabric, and scored for complexity the moment they arrive, so simple claims move and complex ones reach the right desk first.
Anomalies with explanations
Outliers surface with the comparison set and the reasoning that flagged them, so reviewers can act instead of investigating the model.
Payment integrity you can evidence
Every adjustment references the policy version, contract terms, and clinical evidence applied, producing an audit trail that stands up long after the payment cycle closes.