An AI-led shift to speed, structure, and scalability

As a strategic partner, Virtusa implemented and now manages the ClarifAI platform end-to-end. This generative AI (genAI)-powered solution automates repetitive steps, improving data accuracy and enabling real-time support for appeals specialists.

The AI solution proactively surfaced the correct data, documents, and subsequent actions based on the context of each appeal, resulting in fewer delays, reduced errors, and dramatically lower operational burden on their human counterparts.

Key AI-led enhancements included:

Context-driven data retrieval: Pulling of relevant documents and case information in real time from disparate systems, triggered by metadata and appeal type.
Embedded compliance logic: Pre-built regulatory rules automatically enforced documentation requirements, minimizing audit risk and manual oversight.
Live decision support: In-the-moment prompts, flagged missing inputs, and surfaced exceptions to help appeals agents take the right actions faster.
Unified access via SOP Hub: A clear, all-in-one view of relevant data and documents, minimizing system switches and speeding up case handling.

Together, these AI capabilities transformed appeals from a fragmented, manual process into a streamlined, intelligent workflow, accelerating turnaround times, improving accuracy, and alleviating compliance pressure.

~ 37 mins

60%

$10.1M

87%

90%

Services

Industries

Insights

Careers

About