Sample your own claim decisions against the evidence and your playbook.BETA
Claims review quality sampling software, in beta, is an internal quality tool your carrier opts into: it compares a sample of your own claim decisions against the record evidence and your organization's own playbook, surfacing mismatches for training and process improvement, never as an independent audit of any individual adjuster.
Every sampled decision, checked against the record.
The sampler pulls the decision an adjuster made, the pages that supported it, and lines both up against the carrier's own playbook criteria. Mismatches are flagged for review, not scored against the person who made the call.
Built for training, not for surveillance.
Your team chooses the sample: which claims, which time window, which criteria matter. The output feeds directly into the training and coaching work you already run, and it never leaves your organization.
An internal QA tool, not an independent audit.
This is opt-in and carrier-controlled. The Sampler does not watch or score your adjusters independently. A carrier chooses to run it, on a sample it selects, against the evidence in the record and the playbook the carrier itself wrote.
The output is a QA input, not a personnel decision. Findings feed into the training and process-improvement work you already run; how, or whether, any finding connects to an individual's review is governed entirely by your own HR and training policies, never ours.
From sample to training input, in three steps.
No independent surveillance, no scoring of individuals, just a QA tool your team controls end to end.
Pick the claims, the time window, and the criteria you want reviewed. Nothing runs without your selection.
Each decision is checked against the cited evidence and your own playbook criteria, page by page.
Findings land in a report your team applies under its own training and process-improvement policies.
Built for the teams that run their own QA.
An opt-in tool for the organizations that already own the training and coaching process.
Claims Review Quality Sampler, answered.
An opt-in internal QA tool: it samples a set of the carrier's own claim decisions and checks them against the record evidence and the carrier's own playbook, for training and process improvement.
No. It doesn't independently score, rate, or rank adjusters. It's a QA tool the carrier applies under its own HR and training policies; how any finding connects to an individual review is entirely up to the carrier.
The carrier does, entirely. You choose the claims, the time window, and the criteria; nothing is sampled without your selection.
As an internal training and process-improvement input. Findings feed into whatever coaching or QA workflow you already run; the sampler doesn't publish, share, or act on the results itself.
Yes, in beta. The Claims Review Quality Sampler is live and testable now; we're refining it hands-on with early customers, and if your use case is a good fit we'll work with you directly.
Related capabilities.
Try the Quality Sampler on your own claims.
Join the beta and run a sample against a set of your own claim decisions, or book a demo to see it first.