Platform layers
Each layer of ClaimSense is designed for specific responsibilities, ensuring scalability, maintainability, and seamless integration.
Layer 1
Business workflow layer
The user-facing application layer where claims handlers interact with the system. Provides intuitive interfaces for case management, decision-making, and collaboration.
- ›Case management dashboard
- ›Task queues and workflows
- ›Reporting and analytics
- ›Master claim workspace and linked specialist workstreams
- ›Accountable end-to-end tasks and process subtasks
Layer 2
AI agent layer
The intelligence layer powered by LLMs and specialised AI models. Processes claims, extracts information, and provides decision support.
- ›Document understanding
- ›Decision recommendations
- ›Natural language search
Layer 3
Core system layer
The data foundation layer storing all claim data, states, and transaction history. Ensures auditability, compliance, and data integrity.
- ›Claim state management
- ›Full audit trails
- ›Data integrations
- ›Parent-child claim relationships and shared case context
- ›Permission-aware information sharing across linked workstreams