Payment Integrity Command Center
Maya Thompson • Claims Broker
Starts the morning in the prioritized review queue, opens the highest-risk claim, and decides what action to take next.
SIU / Risk Team
Receives transferred risks with evidence, indicators, timeline, and a case summary instead of a raw alert.
Director of Payment Integrity
Opens Impact to see what happened across claims, who acted, how effective the search was, and estimated leakage reduced.
Top suspicious claims
| Claim | Provider | Risk | Exposure | Flags |
|---|
Recent activity
Ingestion jobs
Model monitor
Assigned work
Who uses the product and what each person gets
Maya starts her day in My Queue. The system has already sorted suspicious claims by risk, SLA, and exposure.
She clicks the top claim and immediately sees risk score, indicators, peer comparison, evidence, and recommended next step.
She can accept the finding, transfer the risk, request documents, or run additional indicators before escalating.
Every action rolls into Impact: claim-level decisions, estimated leakage reduced, productivity, and audit trail.
What the broker gets
A concrete daily worklist, not another dashboard. The value is that the broker knows what to open first and what action to take next.
What the manager gets
A management view of whether the team is converting AI signals into operational outcomes: actions taken, risks transferred, dollars protected, and queue velocity.
My Queue
Provider Risk Signals
Actions, ROI, and team effectiveness
What the manager can show upstairs
Claim-level decisions, action owner, risk score, exposure, SLA performance, and the operational outcome for each case. It is built for a Director of Payment Integrity who needs a defensible weekly report, not just a queue screenshot.
How the report proves search quality
The report separates accepted signals, transferred risks, documentation requests, legal escalations, provider-relations referrals, and cases needing more indicators. That lets management see whether the AI is surfacing useful work, not just generating alerts.
Claim-by-claim action report
| Claim | Broker action | Action owner | SLA | Risk | Exposure | Manager view |
|---|
Decision protocol
How actions are routed after review