Elysian, an AI-native third-party administrator (TPA) and claims quality platform, has launched two tools designed to give insurers broader oversight of claims handling across entire portfolios.

The New York-based company has introduced Ely Audit and Ely Adjust, which approach claims quality from different points in the lifecycle. Ely Audit reviews claims files across a portfolio to identify risks and patterns, while Ely Adjust continuously monitors open claims and provides guidance while outcomes can still be influenced.

The launch targets a limitation in traditional claims audit programmes, which typically review only around 2% of a carrier’s claims. Elysian said this can leave insurers with limited visibility into the quality and consistency of handling across the wider book.

Ely Audit is designed to review an insurer’s full portfolio, including both open and closed claims, rather than relying on periodic sampling. The platform connects with existing claims technology and can analyse longer-tail claims containing thousands of documents.

The tool evaluates handling quality, compliance with agreed standards and the performance of external vendors. Rather than reducing the assessment to a pass-or-fail result, Elysian said it generates detailed evaluations covering risks, trends and opportunities across the portfolio.

The company said insurers can use these findings to identify problematic handling practices and address them before they affect additional claims.

Ely Adjust takes the same approach into live claims. The system reviews every open claim daily, identifying developments that may require attention and providing handlers with recommendations on potential next steps.

Adjusters remain responsible for decisions and actions, with Ely Adjust designed to recommend rather than automatically determine the outcome of a claim.

Source link