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Trusted Enterprise AI for data-intensive organizationsAWS · Databricks · Azure · Human judgment by design
Payer, claims, clinical operations, member, provider, quality, risk adjustment, SIU, compliance, and data leaders
Health Insurance data + AI transformation
Health plans need to reduce administrative friction and improve member outcomes while protecting PHI, preserving clinical judgment, and operating within complex reimbursement and regulatory rules. Infinitive connects the systems you already run to trusted data and AI so teams can improve outcomes without separating innovation from governance.
Speak the language of the business
Start from the operating model—not the model.
Claims adjudicationPrior authorizationRisk adjustmentStars / qualityProvider networkUtilization managementFWAMember servicePHI
We use the language, measures, controls, and workflows your teams already operate, then connect them to modern data and AI capabilities.
Shop / enrollImprove plan comparison, eligibility, enrollment support, and member education.
Access careHelp members navigate benefits, networks, referrals, and prior authorization requirements.
Receive careUse claims and clinical signals to support care management, quality, and high-risk member outreach.
ResolveImprove claims, appeals, grievances, explanations, and issue routing.
Manage healthSupport preventive care, adherence, care gaps, and member engagement with appropriate human clinical oversight.
RenewUnderstand experience, utilization, affordability, and retention drivers.
Member servicesGets a benefit-aware member summary, approved answers, and escalation guidance.
Claims / payment integrityUses AI to prioritize exceptions, summarize evidence, and detect patterns.
Clinical / UM teamReceives longitudinal context and guideline retrieval while retaining clinical decision authority.
Data / complianceGovern PHI access, lineage, policy, model use, and evidence across workflows.
Use case 01
Claims adjudication and payment integrity intelligence
Claims operations must distinguish clean claims, coding variation, contract rules, clinical context, and payment anomalies at high volume.
Trusted data on Databricks
Unify claims, eligibility, provider contracts, coding, clinical rules, prior authorization, payment, and adjustment history.
AI at work
Prioritize exceptions, explain likely causes, detect patterns, retrieve applicable rules, and assemble evidence for analyst review.
How Infinitive helps
Modernize claims data pipelines, create governed payment-integrity data products, implement AI review workflows, and measure recoveries and cycle time.
Human accountability
Claims and payment-integrity staff approve adjustments, recoupments, and provider communications.
Measures to improveAuto-adjudicationException cycle timePayment accuracyRecovery yieldProvider abrasion
Use case 02
Prior authorization workflow acceleration
Prior authorization involves benefit rules, clinical criteria, documentation completeness, provider communication, and time-sensitive decisions.
Trusted data on Databricks
Connect eligibility, benefit design, authorization history, clinical documentation, guidelines, provider data, and correspondence.
AI at work
Extract documentation, identify missing evidence, retrieve criteria, summarize the request, and route cases by complexity or urgency.
How Infinitive helps
Build the governed data and document layer, integrate utilization-management platforms, design review workflows, and monitor quality and timeliness.
Human accountability
Licensed clinical reviewers retain medical-necessity and exception decisions.
Measures to improveTurnaround timeIncomplete submissionsClinical reviewer capacityAppeal rateProvider experience
Use case 03
Member service and benefit intelligence
Members struggle to understand coverage, cost, network status, claims, and next steps, while service agents navigate multiple systems.
Trusted data on Databricks
Combine benefits, accumulators, claims, provider network, prior auth, interactions, documents, and approved knowledge.
AI at work
Prepare member context, retrieve plan-specific answers, explain claim status, summarize prior contacts, and route sensitive issues.
How Infinitive helps
Implement governed member context, retrieval, contact-center analytics, workflow integration, and adoption controls.
Human accountability
Agents retain responsibility for empathy, complex benefit interpretation, complaints, and escalation.
Measures to improveFirst-contact resolutionHandle timeRepeat contactsMember satisfactionEscalation quality
Use case 04
Risk adjustment and documentation intelligence
Risk-adjustment teams need accurate, supportable coding and documentation while avoiding unsupported inference or overreach.
Trusted data on Databricks
Connect claims, encounters, clinical documentation, provider data, chart-review status, coding guidance, and audit evidence.
AI at work
Prioritize records, retrieve evidence, summarize documentation, and flag coding opportunities or inconsistencies for qualified review.
How Infinitive helps
Build governed data products, document processing, workflow queues, audit trails, and monitoring.
Human accountability
Certified coders and clinicians validate documentation and final coding decisions.
Measures to improveChart-review productivityEvidence completenessCoding accuracyAudit response timeDocumentation quality
Use case 05
Provider network and quality intelligence
Network leaders balance access, cost, quality, performance, capacity, and geographic coverage across thousands of providers.
Trusted data on Databricks
Unify provider directories, claims, quality, access, contract, credential, member, and geographic data.
AI at work
Identify network gaps, provider anomalies, quality trends, referral patterns, and capacity constraints; summarize root causes for action.
How Infinitive helps
Build network data products, geospatial analytics, decision-support experiences, and governed metrics.
Human accountability
Network and clinical leaders approve contracting, remediation, and member-impact decisions.
Measures to improveDirectory accuracyAccess gapsQuality performanceNetwork costProvider-management efficiency
Use case 06
Fraud, waste, and abuse investigation support
SIU teams investigate complex relationships across claims, providers, members, codes, locations, referrals, and prior cases.
Trusted data on Databricks
Bring claims, provider, member, referral, payment, geospatial, case, and external data into governed investigation-ready structures.
AI at work
Surface anomalous patterns, related entities, recurring schemes, case summaries, and evidence paths for investigator review.
How Infinitive helps
Design the investigation data model, graph and anomaly analytics, AI workspaces, and case integration with auditability.
Human accountability
SIU investigators determine case disposition, referrals, and external reporting.
Measures to improveCase prioritizationInvestigation cycle timeEvidence qualityRecovery opportunityRepeat-pattern detection
01ActivateDefine a priority problem, establish trusted data, and demonstrate value through a focused engagement or POC.
02ProductionizeMake the capability secure, reliable, governed, measurable, and useful in everyday operations.
03ScaleExtend proven value across teams, workflows, data domains, and business areas—only where evidence supports it.
Why Infinitive
Trust is part of the architecture and the operating model.
Infinitive combines data and AI delivery with governance, risk, transformation, and adoption so the same team can address the technical path and the organizational conditions that determine whether AI actually works in practice.
Build on enterprise realityConnect core systems, controls, teams, and existing investments rather than designing a disconnected AI island.
Govern at design timeData access, lineage, security, policy, auditability, cost, and human decision rights are defined before production.
Prove value before scaleUse a focused entry point with business measures so the next decision is based on evidence—not enthusiasm.
Keep people accountableAI can automate preparation and pattern finding; people remain at judgment, exception, empathy, and accountability.
Health Insurance next step
Choose one workflow where better data and AI could change the outcome.
Bring the business owner, data/platform lead, and operating or risk leader. Infinitive will help frame the use case, required data, governance needs, human decision points, and the right Activate, Productionize, or Scale path.
