Claims ingestion and extraction
Process claims from members and providers, normalize documents and attachments, and extract structured fields for downstream review.
Insurance & payers
Applied AI for claims, adjudication, underwriting, and payment integrity.
Atomix helps carriers and payers convert claims from members and providers into structured intelligence, then deploys agents that support analytics, adjudication, underwriting, and fraud, waste, and abuse review.
AtomixPayer Operations
Live · 3 active
Approved
DiagnosisICD-10 Z51.11
Clinical criteriaMet
ProviderIn-network
Benefit coverageConfirmed
Auth #PA-7821 issued · 365-day validity · Policy #GRP-0094
UM Review
LOS 11 days — DRG benchmark is 7 days. Utilization management escalation triggered.
Processing…
Checking formulary tier and step therapy requirementsPolicyClinicalEvidenceControls
Carrier operating layer
From claim packets to reviewable AI decisions
The system is built for high-volume claim environments where policy logic, provider behavior, evidence lineage, and human review all need to work together.
Advanced analytics agents
Ask operational questions, find claim cohorts, surface payment trends, and turn claim data into repeatable analytics workflows.
Adjudication support
Route claims through AI-assisted policy checks, coding review, exception queues, and human-in-the-loop decisions.
Underwriting intelligence
Convert historical claims into structured underwriting inputs while preserving traceability back to the underlying evidence.
Fraud, waste, and abuse
Detect suspicious billing patterns, provider anomalies, duplicate submissions, and outlier utilization before losses compound.
Carrier operating layer
Connect claims intake, review, analytics, and policy operations in one system that adapts to carrier rules.
Business impact
Measurable outcomes for carriers and payers
Atomix targets the highest-value levers in a carrier operation: payment integrity, adjudication throughput, claims intelligence, and audit defensibility.
Payment integrity
Flag fraud, waste, and abuse patterns across claims — closing a recognized 5% savings opportunity for carriers that act on it.
Adjudication efficiency
Route claims through policy checks, coding review, and exception queues without adding headcount to match volume.
Claims intelligence
Turn structured claim data into repeatable operating reports — denial patterns, adjudicator throughput, and cost per claim.
Audit-ready decisions
Every field extracted from a claim document links back to its source — ready for regulatory review or dispute resolution.
Insurance estimator
Your portfolio could recover $2,854,400 per year.
Model FWA recovery and administrative savings using aggregate claim volumes only.
Annual claims value$24,000,000
FWA savings$614,400
Admin savings$2,240,000
FWA savings $614,400 · Admin savings $2,240,000
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Carrier walkthrough
Bring one claims workflow and one measurable operating goal.
Atomix will map where extraction, analytics agents, adjudication support, and FWA review can fit into your current carrier operation.