The kind of team this fits: a health claims TPA, roughly 5,000 claims a month across a group health book.
The morning before
5,000 claims a month and a six day cycle means most claims sit in a queue behind the ones that actually needed manual attention, waiting their turn regardless of how straightforward they are.
Image, the morning beforeA photo or illustration of what this looks like today, before any of this runs.
How this could run
Not a feature list. The actual sequence, from the moment the case lands to the moment someone signs it.
- 01
Intake validates itself
Claim documents, EHR, bills and co-pay data are checked for completeness the moment they arrive.
- 02
Anomalies get flagged before payment, not after
Coverage terms and provider billing patterns are checked for anomalies and fraud signals.
- 03
Every decision comes with its reasoning
Approval or rejection arrives with documented rationale, not a code a reviewer has to interpret.
Image, inside Zen StudioScreenshot of a Zen Studio canvas configured for a workflow like this one.
What doesn't change
A reviewer still signs off on adjudication. What changes is how much of the file they have to read before they can.
What this could mean
Illustrative, based on the shape of a workflow like this one. The real number depends on the case, the team, and how it's configured.
6 days → 3 hoursClaim intake to adjudication decision
80%Claims auto adjudicated without manual review
Image, inside Zen PilotScreenshot of the Zen Pilot dashboard or explainability panel for a run of this workflow.
Where this lives in the platform
For a claims adjudication lead, a workflow like this starts as a conversation with Zara, describing the process in plain language and getting a first draft of the team back in the same session. Zen Studio is where engineering opens that draft, sets the guardrails node by node, and versions it before it goes live. Zen Pilot is where it actually runs, and where anyone can watch a case move through it in real time, node by node, with the reasoning attached.
