AI EMPLOYEES
Automate claims processing with agentic AI
Accelerate adjudication, reduce rework, and improve payment accuracy—without replacing your core claims system.
Claims Processing (Payers)
Healthcare Payers
3,023
Running
10x
Faster claim throughput
Why claims operations struggle to scale
Fragmented systems
Multiple legacy systems and manual processes create bottlenecks and inconsistent adjudication outcomes.
30–45 minutes per claim spent navigating multiple platforms
High error rates
Inaccurate data entry and complex rules drive costly payment errors and member dissatisfaction.
5–10 % of claims contain data or coding inaccuracies
Rising administrative costs
Payers spend millions annually on manual claim handling, adjustments, and rework.
20–25 % of total operating expense tied to manual claim handling
AI-powered claims automation
Data validation and enrichment
AI employees validate claim data against eligibility, provider, and policy information before adjudication.
Automatically classify and route claims based on complexity, provider type, and line of business.
Apply payment rules, detect discrepancies, and pre-flag potential denials or duplicates.
Audit processed claims and identify overpayments or missing data for correction before payment.
1) Data validation
AI employees extract and validate claim data against payer rules and provider contracts.
Results you can measure
10x
Faster claim throughput
Reduce cycle time from days to hours with agentic automation.
2–3 weeks
Typical time to go live
Deploy fast without heavy integrations.
100%
Audit-ready transparency
Every action is logged for compliance and internal QA review.
90%
Reliability on end-to-end workflows
Reduce operational costs while improving provider experience.
What healthcare payers are saying
“Claims accuracy went up immediately after deployment. The AI flags duplicates, coding errors, and out-of-policy claims before they ever reach payment.”
“Magical integrates seamlessly with our legacy systems. We went live in under a month and cut claim turnaround by 80% without touching our core platform.”
Security & compliance
HIPAA compliant
Magical processes all data locally with zero PHI storage
SOC 2 Type II certified
Enterprise-grade security with regular third-party audits
Secure Authentication
Single Sign-On (SSO) and multi-factor authentication options
See automated claims processing in action
What systems does this integrate with?
Works with major payer platforms including QNXT, Facets, HealthEdge, and custom legacy systems.
How accurate is the automation?
AI employees maintain 95%+ accuracy and continuously self-correct through AI judge monitoring.
Does it support pre- and post-payment audits?
Yes—Magical automates validation both before and after adjudication, preventing overpayment and leakage.
Can it handle attachments and unstructured data?
AI reads PDFs, scanned docs, and EDI data to extract relevant claim details automatically.
How long to implement?
Payers typically go live in 3–4 weeks without any core system modifications.
