VeltrixONE Claims Processing
A claims command center for any organization that receives, reviews, and pays claims at scale, including reimbursement programs, settlement and compensation funds, cost-recovery programs, and benefits administrators. AI agents pre-screen every claim, reviewers work in parallel instead of in sequence, and every determination carries a documented rationale.
Billions in Claims Cannot Run on Spreadsheets and Email
Large claims programs are usually managed across spreadsheets, email chains, and disconnected tools. That creates compliance risk, payment delays, and audit exposure that grows with every claim.
Claim Sprawl
Thousands of cost line items, complex cost catalog mapping, and no single intake system to hold them.
Limited Visibility
Claim status is scattered across inboxes, spreadsheets, and individual reviewers, with no single source of truth.
Manual, Sequential Review
Finance, technical, and legal reviews happen one after another. Every handoff adds time and room for error.
No Audit Trail
Approval decisions lack documented rationale, which creates regulatory and legal exposure when determinations are challenged.
The Three-Party Claims Model
VeltrixONE Claims runs on the same three-party engine that powers VeltrixONE Workforce Management. The funder plays the role of the hiring client, the claims administrator plays the gatekeeper, and claimants play the role of vendors.
Program Funder and Oversight
The organization that funds the program, and any parties obligated to pay into it, get full transparency without having to chase status.
- Funding obligations calculated and tracked in the platform
- Billing statements generated automatically for each obligated party
- Payment receipts logged against obligations in real time
- Read-only access to program reporting and the Reporting Agent
- Audit and compliance reporting for oversight bodies
Claims Administrator
The team that receives, reviews, and decides every claim runs the program from one command center.
- Receives and screens every claim with AI-assisted intake
- Batches claims and schedules concurrent reviews
- Runs finance, technical, and legal review tracks in parallel
- Leads review, QC sampling, and decisional memos
- Issues determinations and sends approved claims to ERP for payment
Claimants
Organizations and individuals seeking reimbursement or compensation get a guided, transparent path from submission to payment.
- Self-service profile and eligibility setup
- Guided claim intake with cost line entry and document upload
- Cost catalog alerts at submission, not after review
- Respond to requests for information inside the portal
- Track status, determination, and payment confirmation live
Every Claim Pre-Screened Before a Human Opens It
Specialized agents handle the repetitive checks so reviewers can spend their time on judgment. Each agent hands a scored, explainable finding to the human reviewer, who accepts, overrides, or escalates.
Completeness Scoring
Checks every submission for required fields, required documents, and control table matches, then hands the reviewer a scored completeness report.
OCR and Tamper Detection
Extracts data from invoices, contracts, and proof of payment. Classifies fields with confidence scores and flags duplicate invoices and altered documents.
Cost Validation
Validates cost fields, GL coding, and invoice amounts against the cost catalog and allocation tables, and flags outliers before the finance reviewer begins.
Multi-Vector Fraud Detection
Looks for identity anomalies, synthetic identities, document tampering, vendor patterns, suspicious relationships between parties, and payment fraud signals.
Regulatory and Documentation Checks
Checks regulatory compliance, documentation authenticity, and litigation hold triggers, and raises issues before legal review starts.
Conversational Reporting
Reviewers and executives ask questions in plain language and get formatted, exportable reports on demand. No report builder required.
From Submission to Determination
A Case Coordinator agent orchestrates the others, routes work to human review queues, and manages escalations.
Claim Submitted
Claimant portal, guided intake, document upload
Intake Agent
Completeness check, control table validation, confidence score
Document Agent
OCR extraction, confidence scoring, tamper detection
Fraud Agent
Identity anomalies, duplicate invoices, relationship analysis
Concurrent Review
Eligibility, finance, and legal agents pre-screen in parallel
No flags or exceptions
The system recommends approval and drafts the determination notice. A reviewer confirms, and the approved package moves to ERP for payment.
Flag or exception raised
The claim routes to a human-in-the-loop queue. The reviewer accepts, overrides, or escalates, then lead review and QC sampling produce a decisional memo before approval or denial.
Complete Coverage, Clear Roles
Claimants use the claimant portal only. The claims administrator operates the review and payment modules. Funders and oversight bodies receive reporting and billing statements.
Claimant Portal
Profile, claim submission, document upload, status tracking, and RFI responses.
ClaimantsIntake and Completeness
Intake Agent, completeness scorecard, and control table validation.
AdministratorBatch Planning
Case Coordinator agent groups claims into batches and proposes reviewer assignments.
AdministratorConcurrent Review
Finance, technical, and legal tracks run in parallel for every batch.
AdministratorLead Review and QC
Lead reviewer consolidates tracks. QC samples 10 to 25 percent of each batch as a hard gate.
AdministratorOCR and AI Documents
Document Agent, OCR extraction, fraud flags, and tamper detection.
AdministratorApproval and Disputes
Full and partial determinations, claimant notification, and an Appeal Agent that assembles dispute packets.
AdministratorERP and Payment
Payment package out, confirmation in, GL coding rules, obligation billing, and reconciliation.
AdministratorSecurity and Audit
Validated encryption, NIST SP 800-53 Moderate control alignment, MFA, RBAC, and immutable audit trail.
AdministratorReporting Agent
Conversational reporting across every module, with export and scheduled delivery.
All PartiesEnd-to-End Workflow Automation
From claim submission, to concurrent review, to payment confirmation, managed in one platform.
Claimant Submits Claim
Profile creation, guided intake, cost line entry for up to 1,500 lines, document upload, and cost catalog alerts at the moment of submission.
Intake and Completeness Review
The Intake Agent validates completeness, checks for duplicates, and validates control tables. Deficient claims return to the claimant automatically.
Batch Planning and Assignment
The Case Coordinator agent groups claims into batches and proposes finance, technical, and legal reviewer assignments for approval.
Concurrent Multi-Track Review
Three review tracks run in parallel for each batch. AI agents pre-screen each claim and hand their findings to the human reviewers.
Lead Review and QC Sampling
The lead reviewer consolidates all three dispositions. QC samples 10 to 25 percent of claims, and a decisional memo is drafted.
Approval, Payment, and Billing
The determination is issued, the claimant is notified, the approved package goes to ERP for payment, and obligation billing statements are generated.
One View of the Entire Program
Claims, batches, obligations, SLA status, and payment pipeline on one screen.
| Claimant | Claim Value | Batch | Status |
|---|---|---|---|
| CLM-0042 | $12.4M | B-1001 | In Lead Review |
| CLM-0018 | $48.2M | B-1002 | Approved, Payment Sent |
| CLM-0091 | $3.1M | B-1003 | Pending Finance RFI |
| CLM-0033 | $22.8M | B-1001 | QC Sampling |
| CLM-0077 | $8.9M | B-1004 | Denied, In Dispute |
Illustrative data
Control, Clarity, and Faster Payments
Program Funder and Oversight
Always-current visibility into program funding, obligations, and outcomes.
- Obligation calculations and billing statements generated automatically
- Payment receipts logged against every obligation
- Complete chain of custody on every approved claim
- Real-time totals for submitted, approved, denied, and paid
Claims Administrator
Less coordination overhead and fewer surprises at audit time.
- No manual coordination across finance, technical, and legal teams
- AI surfaces fraud signals and compliance gaps before review
- Real-time view of pipeline, SLA compliance, and exposure
- Immutable decision lineage on every claim and batch
Claimants
A standardized process with clear expectations and faster answers.
- Guided intake with completeness checks at submission
- Live status, batch assignment, and review progress
- Consistent evaluation criteria for every claimant
- Automated approval-to-payment workflow shortens time to disbursement