AI-first Health Insurance Operations

Scrubs powers claim operations automation at scale - reducing leakage, improving adjudication consistency and delivering better outcomes.

Our automation brings scalability and consistent precision to manual claims processes and legacy systems.

AI Agents built for the healthcare claims

Multi-agent AI system mimics claims operation workflows, refined by insurance experts and AI researchers.

Scrubs Claims Processing Platform

Live Session

📋 Document Queue (3 pending)

Medical Invoice #12847

processing

Patient: Sarah Johnson

Amount: $285.50

Provider: City Medical Center

🔄 Processing...

Specialist Consultation #15623

validated

Patient: Michael Chen

Amount: $450.00

Provider: Heart Care Specialists

Diagnostic Report #98456

approved

Patient: Lisa Wong

Amount: $320.75

Provider: Advanced Imaging

🤖 AI Processing Engine

📄 OCR Extraction:

✓ Document structure detected

✓ Text extraction complete

✓ Fields and entities extracted

✓ Data validation passed

🔍 Document Validation:

Mandatory fields:✓ Complete

Document quality:✓ Passed

Cross-reference:✓ Verified

⚖️ Rules Check & Adjudication:

General exclusions check: PASS

Benefits eligibility check: PASS

Benefit calculations: DONE

✅ CLAIM APPROVED

171

Claims Today

99.8%

Accuracy

2.3s

Avg. Processing

Accurate, Grounded Processing Across All Your Data

Customized AI models built to learn from your operational staff give you a lasting competitive advantage in claims processing.

Core Technology

Intelligent Document Understanding

OCR + LLM Processing Pipeline

Our proprietary OCR technology combined with large language models reads medical documents like a human expert, extracting meaning from complex layouts, tables, and handwritten notes.

Multi-format support (PDF, TIFF, JPG, handwritten)
Medical terminology recognition
Table and form structure understanding
Cross-document reference linking

# Document Processing Pipeline

📄 → [SCANNING] → Medical Invoice #12345

📝 Converting to markdown...

🏷️ Extracting key fields...

# Extracted Structured Data

{ "patient_name": "John Doe", "patient_dob": "1985-03-15", "invoice_number": "12345", "procedure": "Medical Consultation", "amount": 150.00, "diagnosis": "Hypertension follow-up", "icd10_code": "I10", "provider": "Dr. Sarah Kim, MD", "confidence": 0.985, "handwriting_detected": true, "validation": "PASSED" }

# Policy Document Analysis

🔍 → [PARSING] → Section 4: Exclusions

🧠 Finding rule patterns...

⚙️ Encoding as executable rules...

# Generated Rule Database

RULE_001: Pre-existing_exclusion condition: "pre_existing == true" period: "12_months" action: "DENY" RULE_002: Dental_exclusion condition: "procedure_type == 'dental'" exception: "accident_related == true" action: "CONDITIONAL_APPROVE" RULE_003: Annual_limit condition: "yearly_total > 200000" action: "DENY_EXCESS"

Core Technology

Policy Rule Extraction

AI-Powered Policy Parsing

Advanced AI extracts and structures complex policy rules from insurance documents, converting lengthy policy text into actionable rules that can be applied automatically to claims.

Automatic rule extraction from policy PDFs
Structured rule database generation
Complex condition parsing and logic
Multi-policy rule consolidation

Core Technology

Intelligent Rules Adjudication

Claim-to-Rule Mapping Engine

Our AI system maps individual claim details to extracted policy rules, making granular decisions on each rule and providing detailed recommendations for follow-up actions when needed.

Individual rule-level decision making
Contextual claim-to-rule matching
Automated follow-up recommendations
Confidence scoring for each decision

# Rapid Rule Matching Process

⚡ → [MATCHING] → Claim #CL-2024-5678

🔄 Checking rules...

🔄 More rules...

✅ Final decision...

# Rule-by-Rule Results

RULE_001: Pre-existing_exclusion Status: ✅ PASS (4 months elapsed) Confidence: 0.95 RULE_002: Dental_exclusion Status: ✅ PASS (accident-related exception) Confidence: 0.92 RULE_003: Annual_limit Status: ✅ PASS ($45,500 remaining) Confidence: 1.0 FINAL_DECISION: APPROVED RECOMMENDED_ACTION: Process payment REVIEW_REQUIRED: None

# Enterprise Workflow Designer

Workflow Nodes

┌─ Process A: ● Connected

├─ Validate B: ○ Automated

├─ Route C: ○ Triggered

└─ Report D: ● Generated

# Custom Integration Status

ENTERPRISE_CONFIG: ACTIVE ┌─ Custom workflows: Deployed ├─ Business rules: Integrated ├─ Data pipelines: Connected └─ Monitoring: Live STATUS: Ready for production NEXT: Schedule implementation review

Enterprise Customizations

Custom Workflow Automation

Tailored Enterprise Solutions

Beyond standard processing, we create intelligent automation workflows tailored to each organization's unique operational requirements and business processes.

Custom business logic implementation
Enterprise system integrations
Tailored workflow automation
Bespoke reporting and analytics

We work closely with each organization to identify and implement custom workflows that align with your specific operational needs and compliance requirements.

Core Technology

AI Self-Improvement Engine

Continuous Learning & Accuracy Enhancement

Our AI agents continuously learn from processing outcomes, feedback loops, and operational patterns to improve accuracy and processing efficiency over time without manual intervention.

Real-time accuracy monitoring and optimization
Automated model retraining based on outcomes
Performance benchmarking and trend analysis
Self-correcting error detection and resolution

AI Accuracy Improvement Over Time

99.7%

Current OCR Accuracy

98.9%

Adjudication Accuracy

OCR Accuracy↗ +2.4% this month

Jan:

93.2%

Feb:

95.1%

Mar:

97.3%

Apr:

99.7%

Adjudication Accuracy↗ +1.8% this month

Jan:

91.4%

Feb:

94.2%

Mar:

97.1%

Apr:

98.9%

Modular Deployment Options

Each module is built for plug-and-play integration, allowing you to deploy individual components or the complete platform based on your specific needs.

API Integration

RESTful API endpoints designed for seamless integration with existing claims management systems and enterprise workflows.

Modular Components:

• OCR Module: Document processing endpoint
• Rules Engine: Policy adjudication
• Workflow Automation: Custom process triggers
• Analytics API: Real-time performance data

Plug & Play Ready

Web Platform

Complete web-based platform with intuitive interface, automated workflows, and comprehensive management capabilities.

Integrated Modules:

• Claims Dashboard: Centralized processing hub
• Analytics Suite: Performance monitoring tools
• Data Pipelines: Enterprise system integration
• Admin Console: User and system management

All-in-One Solution

Cloud-First Architecture

Deploy individual modules independently or as a unified platform—designed for modern cloud infrastructure with enterprise security.

Cloud Native

Fully managed cloud deployment

Virtual Private Cloud

Dedicated cloud environment

BYOC (Bring Your Own Cloud)

Deploy in your cloud account

Enterprise Security

Built for Enterprise Security Standards

Scrubs will comply with enterprise-grade security and healthcare data protection standards.

Healthcare Compliance

Full compliance with healthcare data protection standards and regulations.

End-to-End Encryption

Enterprise-grade encryption for all data at rest and in transit.

Access Control

Role-based access control with multi-factor authentication and SSO integration.

Audit Trails

Complete logging of all system actions and decisions for compliance.

Security First Approach

All data processing occurs within secure, isolated environments with comprehensive monitoring and logging. Virtual private deployments are available as an option for organizations with strict security requirements. Our platform undergoes regular security audits and penetration testing to ensure the highest levels of protection.

Designed to meet enterprise security standards

Ready to Transform Your Claims Processing?

Join the payer revolution and to streamline your claims operations with AI.