A claims command center for any organization that receives, reviews, and pays claims at scale, including reimbursement programs, settlement and compensation funds, cost-recovery programs, and benefits administrators. AI agents pre-screen every claim, reviewers work in parallel instead of in sequence, and every determination carries a documented rationale.
Large claims programs are usually managed across spreadsheets, email chains, and disconnected tools. That creates compliance risk, payment delays, and audit exposure that grows with every claim.
Thousands of cost line items, complex cost catalog mapping, and no single intake system to hold them.
Claim status is scattered across inboxes, spreadsheets, and individual reviewers, with no single source of truth.
Finance, technical, and legal reviews happen one after another. Every handoff adds time and room for error.
Approval decisions lack documented rationale, which creates regulatory and legal exposure when determinations are challenged.
VeltrixONE Claims runs on the same three-party engine that powers VeltrixONE Workforce Management. The funder plays the role of the hiring client, the claims administrator plays the gatekeeper, and claimants play the role of vendors.
The organization that funds the program, and any parties obligated to pay into it, get full transparency without having to chase status.
The team that receives, reviews, and decides every claim runs the program from one command center.
Organizations and individuals seeking reimbursement or compensation get a guided, transparent path from submission to payment.
Specialized agents handle the repetitive checks so reviewers can spend their time on judgment. Each agent hands a scored, explainable finding to the human reviewer, who accepts, overrides, or escalates.
Checks every submission for required fields, required documents, and control table matches, then hands the reviewer a scored completeness report.
Extracts data from invoices, contracts, and proof of payment. Classifies fields with confidence scores and flags duplicate invoices and altered documents.
Validates cost fields, GL coding, and invoice amounts against the cost catalog and allocation tables, and flags outliers before the finance reviewer begins.
Looks for identity anomalies, synthetic identities, document tampering, vendor patterns, suspicious relationships between parties, and payment fraud signals.
Checks regulatory compliance, documentation authenticity, and litigation hold triggers, and raises issues before legal review starts.
Reviewers and executives ask questions in plain language and get formatted, exportable reports on demand. No report builder required.
A Case Coordinator agent orchestrates the others, routes work to human review queues, and manages escalations.
Claimant portal, guided intake, document upload
Completeness check, control table validation, confidence score
OCR extraction, confidence scoring, tamper detection
Identity anomalies, duplicate invoices, relationship analysis
Eligibility, finance, and legal agents pre-screen in parallel
The system recommends approval and drafts the determination notice. A reviewer confirms, and the approved package moves to ERP for payment.
The claim routes to a human-in-the-loop queue. The reviewer accepts, overrides, or escalates, then lead review and QC sampling produce a decisional memo before approval or denial.
Claimants use the claimant portal only. The claims administrator operates the review and payment modules. Funders and oversight bodies receive reporting and billing statements.
Profile, claim submission, document upload, status tracking, and RFI responses.
ClaimantsIntake Agent, completeness scorecard, and control table validation.
AdministratorCase Coordinator agent groups claims into batches and proposes reviewer assignments.
AdministratorFinance, technical, and legal tracks run in parallel for every batch.
AdministratorLead reviewer consolidates tracks. QC samples 10 to 25 percent of each batch as a hard gate.
AdministratorDocument Agent, OCR extraction, fraud flags, and tamper detection.
AdministratorFull and partial determinations, claimant notification, and an Appeal Agent that assembles dispute packets.
AdministratorPayment package out, confirmation in, GL coding rules, obligation billing, and reconciliation.
AdministratorValidated encryption, NIST SP 800-53 Moderate control alignment, MFA, RBAC, and immutable audit trail.
AdministratorConversational reporting across every module, with export and scheduled delivery.
All PartiesFrom claim submission, to concurrent review, to payment confirmation, managed in one platform.
Profile creation, guided intake, cost line entry for up to 1,500 lines, document upload, and cost catalog alerts at the moment of submission.
The Intake Agent validates completeness, checks for duplicates, and validates control tables. Deficient claims return to the claimant automatically.
The Case Coordinator agent groups claims into batches and proposes finance, technical, and legal reviewer assignments for approval.
Three review tracks run in parallel for each batch. AI agents pre-screen each claim and hand their findings to the human reviewers.
The lead reviewer consolidates all three dispositions. QC samples 10 to 25 percent of claims, and a decisional memo is drafted.
The determination is issued, the claimant is notified, the approved package goes to ERP for payment, and obligation billing statements are generated.
Claims, batches, obligations, SLA status, and payment pipeline on one screen.
| Claimant | Claim Value | Batch | Status |
|---|---|---|---|
| CLM-0042 | $12.4M | B-1001 | In Lead Review |
| CLM-0018 | $48.2M | B-1002 | Approved, Payment Sent |
| CLM-0091 | $3.1M | B-1003 | Pending Finance RFI |
| CLM-0033 | $22.8M | B-1001 | QC Sampling |
| CLM-0077 | $8.9M | B-1004 | Denied, In Dispute |
Illustrative data
Always-current visibility into program funding, obligations, and outcomes.
Less coordination overhead and fewer surprises at audit time.
A standardized process with clear expectations and faster answers.