Claims agent
The claims agent is a health AI agent that explains a claims statement line by line in plain words, tells the member why something was short-paid, and chases the missing document a claim is waiting on.
Explains statements and chases the documents a claim is waiting on.
Free to start with 1,000 runs a month, no card needed. Then you pay for what agents do: runs, messages, calls and scans.
- Customer: Why do I still owe R640 on this?
- Read statement dated 3 OctoberDiscovery Health
- Claims agent: Your scheme paid R1,560 of the R2,200 specialist bill, at the scheme’s rate. The R640 left is the specialist charging above that rate. You could ask the rooms if they’ll accept the scheme rate.
- Customer: Can you ask them?
- Claims agent: I can draft the message for you to send, with the claim details. Want it?
What it does, by business
- Medical aids: answers “why do I still owe this?” without a call centre queue
- Health insurers: explains claims and chases documents, so claims close faster
- Employers: helps staff make sense of claims, privately
How the claims agent works
- Reads a statement the member sends, or the claim from your system.
- Explains each line still owed and why.
- Chases a missing invoice, referral or form.
- Hands disputes to your team with the details.
Questions
What is the claims agent?
The claims agent is a health AI agent that explains a claims statement line by line in plain words, tells the member why something was short-paid, and chases the missing document a claim is waiting on.
Does the claims agent change claim outcomes?
No. It explains statements and gathers documents. Your claims team or the scheme decides every claim.
Can members send a photo of a statement?
Yes. The agent reads it, saves what it says with the date, and uses it in later answers.
What does the claims agent cost?
Free to start with 1,000 runs a month, no card needed. Then you pay for what agents do: runs, messages, calls and scans.
Ollie’s agents give wellness guidance. They don’t diagnose or prescribe, and hand off to a human expert when needed.