DocuGenius handles claim intake, validation, and routing for Canadian carriers and third-party administrators. Built for the document mix — group health and dental invoices, disability APS and functional assessments, multilingual travel claims — and for the cat-surge months when volume spikes overnight.
Canadian carriers and TPAs are processing record catastrophe-claim volumes — 228,000 in a single month in 2024 — on top of document-heavy group health, disability, and travel claims. DocuGenius lets the same team absorb the surge with editable rules and a full audit trail, bilingual EN/FR and audit-ready for OSFI E-23.
Three steps: ingest, validate against rules your team owns, route with a full evidence trail. Sits beside your existing core.
Group health and dental invoices, paramedical receipts, disability attending-physician statements and functional assessments, travel hospital invoices, PDFs, scans, photos, portal uploads — English and French. Multi-LLM extraction handles the document chaos.
Deterministic rules check eligibility, completeness, and plan terms. Your claims and compliance teams edit the rules directly, no developer tickets, no release cycles. Fair, consistent decisions every time, not ten adjudicators reading the same rule ten ways.
Clean claims push straight to Salesforce via our AppExchange app, or to your adjudication core via REST, JSON, and CSV. Exceptions route to adjudicators. Every decision logged with the rule, the model, and the inputs, audit-ready for OSFI E-23 and Fair Treatment of Customers.
228,000
Catastrophe claims Canadian insurers processed in a single month (2024). The surge the AI Claims Employee absorbs without seasonal headcount.
85%
Straight-through processing Manulife already reports. Mid-tier carriers and TPAs get the same capability in an 8-week pilot.
2–3×
Claim volume the same team handles with the AI Claims Employee deployed.
No case study needed — score your own operation. These are the thresholds where adding adjudicators stops keeping up with the volume.
The cost of standing still: a mid-size TPA adjudicating 50,000 claims a month at a typical loaded cost of CAD $6–12 per manual touch is CAD $300k–600k a month of processing — most of it on clean, in-policy claims that never needed a person. And when a catastrophe drops 200,000+ claims on the industry in a single month, that surge is met with overtime and temp staff you can't hire fast enough. DocuGenius clears the routine ~75%, so the same team absorbs the surge: 2–3× the volume, same headcount, every decision audit-logged for FTC and OSFI E-23.
A 15-minute walkthrough on a real document — yours or ours. Pilot environment live in under a day.
The leaders built AI teams. Mid-tier carriers and TPAs need the capability without the build.
DocuGenius
Pilot environment in under a day, measured automation rate in an 8-week parallel run.
Manual / generic OCR / in-house build
An in-house AI program is a multi-year, multi-million build only the largest carriers can fund. Generic OCR breaks on every new form.
DocuGenius
Visual decision rules your claims and compliance teams edit directly. Every decision traces to the rule that fired, audit-ready for OSFI E-23 and FTC.
Manual / generic OCR / in-house build
Black-box AI you can't audit, or RPA scripts that break with every plan or form change.
DocuGenius
English and French documents on one pipeline. Canada / Quebec data residency available for Law 25.
Manual / generic OCR / in-house build
US-cloud SaaS with no French handling and data-residency gaps that procurement and privacy flag at review.
DocuGenius
The same team absorbs a cat-surge month, the routine claims auto-clear and adjudicators work only the exceptions.
Manual / generic OCR / in-house build
Volume spikes mean overtime, temp adjudicators, and a backlog that takes months to clear.
Related reading: The hidden cost of manual claims processing
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