AI-powered document intelligence with domain ontologies and human-in-the-loop accuracy

Overview:

Insurance is a document-heavy industry. Whether it’s policy contracts, medical records, hospital agreements, or reinsurance treaties, most of this data exists in unstructured formats—making it time-consuming to analyze and process.
Intellexi solves this by transforming any document into structured, actionable information using Large Language Models (LLMs) enhanced with domain-specific ontologies and confidence-based human-in-the-loop (HITL) validation.

Insurance Use Cases for Intellexi

1. Automated Claims Adjudication

Manual claims processing often involves reviewing scanned hospital bills, prescriptions, and discharge summaries. This process is error-prone and leads to delayed payouts or incorrect decisions.

Intellexi automates the extraction of:

• Patient and provider details
• Diagnosis and procedure codes
• Line-item billing entries
• Reimbursement eligibility checks based on policy terms
  

This structured data can be directly fed into claims engines, allowing insurers to:

• Automate approvals and exceptions
• Reduce turnaround times from days to hours
• Flag anomalies for fraud detection
  

2. Provider Contract Analysis

TPAs and insurers work with dozens of hospitals and diagnostic centers, each with unique agreements outlining pricing, coverage terms, pre-approvals, and exclusions.

Intellexi can:

• Parse large PDF contracts (100+ pages)
• Extract service pricing terms, procedural coverage, or referral rules
• Structure data to help automate compliance checks and real-time validation during claims processing

Impact: Reduces legal and operational overhead, ensures enforcement of negotiated terms, and improves financial integrity.

3. Policy Document Summarization

Insurers often struggle to make complex policy wording accessible to underwriters, agents, and customers.

Intellexi:

• Summarizes long policy documents into structured key points
  
• Maps conditions, waiting periods, coverage caps, and exclusions
  
• Enables policyholders and staff to query policies in natural language (when integrated with chat interfaces)
  

Benefit: Reduces misinterpretation, improves transparency, and enhances customer onboarding and support.

4. Reinsurance Treaty Understanding

Reinsurance agreements often contain thresholds, risk-sharing ratios, and catastrophe clauses buried in legal text.

Intellexi can:

• Extract key treaty components (like per-risk limits, aggregate caps)
  
• Link them to downstream claims
  
• Support automated recovery calculations and risk ceding decisions
  

Benefit: Improves speed and accuracy of reinsurance recoveries, reduces dependency on legal teams.

5. Regulatory and Audit Readiness

When audits or compliance reviews occur, insurers must provide evidence from multiple document sources.

With Intellexi, teams can:

• Tag and store extracted compliance elements (e.g., consent forms, KYC data, policy disclosures)
  
• Create audit-ready document packages
  
• Track gaps or inconsistencies proactively
  

Result: Stronger audit readiness, less manual prep work, and enhanced regulatory risk management.

Business Impact for Insurers

Intellexi is the foundation for any insurer looking to convert unstructured content into structured intelligence—at scale and with confidence.