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Gothink Claims · from first notice to closing

Every claim decided on the page behind it.

Seven checks from first notice to recovery. Each cites its page and seals a signed receipt.

One signed receipt per step No step can deny a claim Nothing paid unattended until earned
7
checks, one receipt each
0
steps that can deny a claim
0
claims paid unattended until you opt in
1
override revokes it
How a claim moves

Seven checks. Each knows when to stop.

Gothink AIR reads the claim file. Conflicts between documents are kept and cited.

Claim file · read and cited by Gothink AIR 1 · File check 2 · Coverage 3 · Fraud 4 · Triage 5 · Severity 6 · Settlement 7 · Subrogation ready · awaitingcovered · questionclear · refer SIU STP · desk · fieldreserve · reviewSTP-eligible · reviewpursue · none holds: a fieldis missing holds: anythingbut covered holds: SIUreferral opened holds: routedto SIU holds: rangetoo wide holds: review,or not earned never holds —opens referral A named person decides — with the page behind every value already open. Claim file · read and cited 1 · File check 2 · Coverage 3 · Fraud 4 · Triage 5 · Severity 6 · Settlement 7 · Subrogation a field is missing anything but covered SIU referral opened routed to SIU range too wide review, or not earned opens a referral left: the check · right: when it holds for a person
Decided and sealedHeld for a named personOpens a referral, never holds

No step can deny a claim — a person closes it. Every threshold is a starting point for your claims, SIU and actuarial teams.

Earned autonomy

Paid without a person only once earned.

Granted per claim type, from reviewed outcomes — the same autonomy model as the rest of the platform.

PER CLAIM TYPE · FOR EXAMPLE, AUTO GLASS 0a run of clean human reviews Every payment made by a person — every review counted Paid without a person listed types · up to your limit · own receipt One override on a QA sample back to zero · correction referral opens PER CLAIM TYPE · E.G. AUTO GLASS 0clean reviews Paid without a person listed types · up to your limit One override back to zero · correction referral

The number of reviews is set by your error budget; a stricter budget needs more.

Off by default

You choose the claim types

With no configuration, nothing is paid unattended.

Earned

Reviews come first

The console shows how many clean reviews are still needed.

Revocable

One override revokes it

Unattended payments are sampled for QA.

What it reads

The claim file, as it arrives.

The claims pack covers:

FNOL packsDeclarationsPolicy wordingEndorsements Police reportsRepair estimatesInvoicesMedical records Demand lettersProofs of lossAdjuster notes
Policy wording

Reads the clauses

An exclusion becomes a question citing clause, page and sentence.

Medical records

A cited chronology

Encounters, codes, gaps. Treated as PHI, shown only to authorised users.

Intake

Documents find their claim

Late documents are attached and flagged, not re-decided.

Console and evidence

One console for the desk. One trail for the examiner.

Claims console: tiles for claims awaiting a person, paid, paid unattended and expected recovery, above a needs-attention queue
Product screen · claims queueIllustrative · demo data, fictional claims

Claims queue

Accept, modify, override or escalate — by a named reviewer.

Autonomy view

Reviews, errors and clean reviews still needed, per claim type.

Actions outbox

Every payment recorded before it is sent, marked sent or failed after.

Core systems and pilots

Measured before it is trusted.

PieceWhat it doesStatus
Guidewire ClaimCenterPayment, referral and note — with a dry-run check that sends nothingTemplate
Duck Creek ClaimsPayment, task and note, checked the same wayTemplate
Subrogation pilot kitRecovery screen on your closed claims. Nothing leaves the machine.Built
Claims consoleQueue, autonomy, outbox, subrogation backtestCloud · demo data

Templates are refused until verified against a carrier's own tenant.

Status

What is not built yet.

Needs a design partner

A verified core-system tenant

Verified against a carrier's tenant, not ours.

Needs claim history

Litigation propensity

Only trained on a carrier's closed claims with outcomes.

Not claimed

An accuracy figure

The demo uses synthetic claims. It shows behaviour, not accuracy.

Start with your closed claims.

Run the subrogation screen inside your environment, then decide whether to go further.