AI Agent AI-Powered Healthcare Claims Adjudication System Active

Decision & Recommendation Engine

Aggregates all agent findings using ensemble weighting, resolves conflicting recommendations through confidence scoring, generates final Pay/Deny/Pend decision with line-level detail, produces explainable AI decision factors for appeals, and creates member/provider communication templates..

View Core Logic Back to Worker

Parent Worker AI-Powered Healthcare Claims Adjudication System

Agent ID

recommendation-engine

Portal Nexgile-AgentiCare Hub Taft-Hartley Benefits Administration Portal

Sector Multi-Employer Trust Fund Administration & Benefits Management

Status

Operational

Problem Statement

The challenge addressed

Synthesizing findings from multiple specialized agents into a coherent claim decision requires weighing conflicting signals and providing explainable rationale.

Core Logic

How the agent solves it

System Navigation

Explore related components

Portal

Nexgile-AgentiCare Hub Taft-Hartley Benefits Administration Portal

Digital Worker

AI-Powered Healthcare Claims Adjudication System

Current Agent

Decision & Recommendation Engine

Here