Priya
HSA Claims Review Agent
HSA claims arrive in every format from every vendor. Priya reads every receipt, validates eligibility, and prepares the decision - so your reviewers focus on the cases that actually need them.
Where the problem lives today
Documents arrive from everywhere
Customers submitted receipts and supporting documents for HSA claim validation. Documents came from pharmacies, grocery stores, clinics, retailers, and online vendors.
Every claim needs a judgment call
Reviewers had to determine whether expenses were eligible, match receipts to claim details, identify missing information, and document review notes.
Repetitive work. Zero room for error
The manual process was repetitive but required accuracy. Inconsistent receipt formats, unclear merchant descriptions, and partial documentation caused delays and unnecessary escalations.
Inconsistency creates the backlog
Inconsistent receipt formats, unclear merchant descriptions, and partial documentation caused delays and unnecessary escalations - not because the rules were unclear, but because applying them manually at volume is where accuracy breaks down.
What Priya does
Priya reads every receipt and supporting document, validates eligibility against configurable rules, and prepares a decision - routing clear claims for approval and uncertain ones for review with structured notes.
Reads Every Receipt and Attachment
Reads receipts, invoices, and attachments from pharmacies, grocery stores, clinics, retailers, and online vendors - regardless of format.
Extracts the Right Fields
Identifies merchant, date, amount, item category, and eligibility signals from every document.
Validates Against Configurable Rules
Validates the claim against eligibility instructions, product and category rules, and exception thresholds.
Prepares Clear Claims for Approval
Clear claims are prepared for approval - no manual review required for routine, straightforward cases.
Routes Uncertain Claims with Structured Notes
Uncertain claims are routed to review with structured notes and reason codes - so the reviewer has everything they need upfront.
Logs Every Decision with Full Evidence
Every decision includes evidence, extracted fields, confidence scores, and audit notes.
Works Inside Your Existing Systems
Priya connects to the claims platforms, document intake channels, and eligibility systems your team already uses.
Your team stays in control
Claims teams can update the following:
"Every decision includes evidence, extracted fields, confidence scores, and audit notes."
Measured impact
Faster customer reimbursement decisions
Stronger audit trail for eligibility determinations
What's Next
Once Priya proves herself on HSA claims review, the same governed approach extends across other healthcare workflows. Prior authorization processing, explanation of benefits review, provider credentialing, patient document intake, compliance and audit documentation - and countless other processes that still depend on people to handle work that is largely repetitive and rule-based, rather than focusing on higher-value decisions.
Your claims reviewers shouldn't spend their day validating receipts.
See how Priya reads every receipt, validates eligibility, and prepares the decision - so your team focuses on the cases that actually need human judgment.