Case Study: Regional Insurer — Claims Appeals

Problem

Appeal backlog; inconsistent rationale; slow coding lookups.

Approach

Policy retrieval with precedent matching
Draft determinations + citations
Approvals by adjusters

Stack

Guidewire, M365, Internal DBs

Impact

Metric	Before	After
Backlog	Baseline	−41%
Consistency	Low	High (citations)

Artifacts

Trace excerpt