Scaling AI Across Claims, Clinical, and Utilization Management

The Challenge

Like many large insurers, the organization had dozens of promising AI pilots — each solving narrow problems but built in isolation. Teams across claims, utilization management, and clinical operations were re-creating similar rules, decision logic, and models without a shared foundation or governance structure. As pilots grew, so did inconsistency in data definitions, audit controls, and operational alignment. What they needed wasn’t another project — it was a sustainable way to connect and scale what was already working.

The Solution

Productive Edge deployed the Healthcare AI Factory to unify the payer’s AI initiatives under one operational model. The engagement began with a design phase that identified and prioritized over 30 high-value use cases. Next, Productive Edge worked with business and IT stakeholders to create a common data and governance foundation, enabling every team to build from the same compliant and explainable logic. Using components from the Boost Foundry, reusable AI modules — such as document summarization, decision support, and rules orchestration — were assembled and deployed across multiple departments. The result was an enterprise-level AI enablement model that evolved with the organization’s own teams.

The Results

In less than a year, the payer established a functioning AI Factory that accelerated the delivery of 30+ AI use cases across major operational domains. Manual review times were cut in half, and new AI-driven workflows went live up to 70% faster. Teams gained transparency and control through standardized governance and monitoring dashboards, while leadership saw measurable productivity gains and improved audit readiness. The Factory now serves as the foundation for scaling AI safely and repeatably across the enterprise.