For TPAs and claims BPOs

You don’t own the loss ratio.You own the audit that explains it.

Taiso checks every coverage call and reserve entry against the policy and the file it came from — escalates only what it can't confirm to your adjusters, and closes each claim with documentation your carrier accepts. Same adjusters. Every file covered.

Run a parallel pass on settled files →See it run on a claim file
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The files you sampled aren't the files that leaked

You can't audit your way
to a documented file.

Your carrier asks for documented files. Your QC reviewed a sample — so the documentation stops exactly where the sample stopped.
Leakage never announces itself. It sits in coverage calls and reserve entries nobody re-opened.
Cycle time is the number the carrier scores you on, and every manual check you add makes that number worse.
You can't hire adjusters fast enough for the volume you already have — let alone for the next CAT surge.

More adjusters buys you more sampling. It does not buy you a file you can defend.

See it run — one hundred settled files

Watch every claim file get checked.
Not a sample.

A two-and-a-half-minute walkthrough of one hundred settled claim files — narrated by the operations lead who signs off on them.

STEP 1 OF 6Your desk today
NarratorOne hundred settled claim files close on your desk today.
Settled files · 100 claims10 sampled · 90 unopened
Taiso verification gate — every coverage call and reserve entry checked against the policy and the file, before the claim closes
sampled by an adjusterclosed unopenedchecked against sourcethe unconfirmed few
90files closed that nobody re-opened
10files your QC actually sampled

The ninety you didn't re-open are the ninety you still answer for.

0of 100 checked against the policy and the file
confirmed0
the machine couldn't confirm0

No adjuster re-reads a file.

Claim 41 of 100Bodily injury claim — coverage limit applied
The file paid$96,500
The policy says“Per-occurrence limit of $75,000 applies to this coverage part.”
VerdictDISPUTED · held for a human
Paid over limit, closed clean. The kind of leakage a sample audit finds a quarter later, if it finds it at all.
Adjuster queue0
Your adjusters open these ten — not all one hundred. The same hours you spend on the sample today, spent where the money actually moves.
Documented file0 / 100
confirmed0
decided by an adjuster0
closed unopened0

The file your carrier and your auditor accept.

Sampled QC10 leakage events closed — found a quarter later, if ever. Your adjusters re-checked the rest by hand.
Verified claims0 files closed unchecked · 10 decided by an adjuster · 100 documented. Same review hours.
Run a parallel pass on settled files →
←/→ step through · space plays · V mutes

Illustration of the mechanism on a hundred settled claim files. Volumes and counts are illustrative, not measured results — the exception rate most of all. How many items actually need a person is the number the parallel run measures on your own work, and it is the number that decides whether the hours hold.

What the arithmetic actually is

Your coverage today,
and the same hours under a gate.

10%
of settled files your QC samples
100%
checked against policy and file
0
files closed unopened

The adjuster hours do not change. What they are spent on does.

Every file, not a sample

One hundred percent of the files.
At the cost of your sample.

Taiso reads every file, checks each coverage call and reserve entry against the policy language it rests on, and routes only what it can't confirm to your adjusters. Their hours stop going into re-reading and start going into the calls that move money.

Todayyou sample the files
sampled by an adjusterclosed unopened — your leakage

Everything you didn't re-open, you still answer for.

With Taisoevery file, checked
checked against policy and file, closedthe few nobody could confirm → your adjusters
in the documented file — the record your carrier accepts

Same review hours. Every file systematically checked. The machine reads all of it; your adjusters decide the few it couldn't confirm — and every decision lands in the file.

Start with Taiso Verify on a single workflow — no migration, and nothing new for your team to learn. Scale to the Taiso Agent Control Platform — your whole claims operation, verified.

Where the check sits

Five checks
on every claim decision.

01
Intent
Does the decision answer what the claim actually asked?
coverage question answered with a reserve change → mismatch
02
Evidence
Is the fact in the file, or did the model infer it?
per-occurrence limit located in the declarations page → supported
03
Policy
Does the handling follow your claims procedure?
settlement above authority routed without approval → blocked
04
Risk
What does this cost you if it's wrong?
payment above the policy limit → an adjuster decides, not the model
05
Audit
Is the decision recorded, sourced and replayable?
decision, policy language, verdict, adjuster, timestamp → documented file

Five checks, one verdict — ALLOW — before the claim closes.

Before the carrier calls

What the carrier asks
before you touch a claim file.

CARRIER DATA
Claim files stay inside your boundary
Deploy in your own environment and nothing leaves it. On the hosted path it runs under a DPA with a no-training clause and retention you set — which is also what your carrier's vendor review will ask for.
YOUR CLAIMS SYSTEM STAYS
We sit behind it, not in front of it
No migration, no replatforming. The gate checks what your system produces and routes the exceptions back into the queue your adjusters already work.
YOUR ADJUSTERS
Scarce people, spent where money moves
You cannot hire your way out of the volume. Adjusters stop re-reading settled files and spend the same hours on the ones where the reserve or the coverage call is actually wrong.

On certification: SOC 2 Type I is on the clock, and Type II is what most financial buyers gate on — we are not going to pretend otherwise. Closed work is still confidential data, so the pilot runs under NDA and a DPA, in your environment or ours, and goes through the same security review your clients require of any new processor. We will fill in the questionnaire.

What stays with the account

The documentation compounds.
The next carrier audit starts ahead.

DOCUMENTED FILE
A record your carrier accepts
Every coverage call, the policy language it rests on, the verdict, and the adjuster who decided it — attached to the claim, not reconstructed after the fact.
LEAKAGE YOU CAN POINT AT
A number, not an impression
The parallel run tells you what closed wrong on files you have already settled — with the file numbers, so you can go and look.
YOUR EXCEPTIONS
The judgment stays yours
Every call your adjusters adjudicate sharpens what gets escalated next time. The queue gets shorter while the record gets longer.

By day 3 you see what it would have caught on your own settled files. By day 14 you have the documentation and the leakage list — yours to keep either way.

Recognise this?

What the account review
always turns up.

THE CARRIER ASKED
“Show me the documented file.”
You have a QC sampling rate and a procedure document. They wanted the file, the policy language, and who decided.
QC MADE CYCLE TIME WORSE
Every check you added cost you a day
Accuracy and speed trade against each other, because both are paid for in adjuster hours.
SURGE IS COMING
Volume you can't staff for
CAT season or a new program doubles the file count, and the sampling rate quietly drops to whatever the team can absorb.

If two of these are true, the pilot below was built for you: files you have already settled, and nothing in production changes.

The offer

One hundred settled files.
Your own leakage number.

Give us a set of claims you have already closed, under NDA. We run them in parallel — no live file is touched, no carrier is involved — and we hand back what the pipeline caught, what your sample missed, and what we got wrong. Bounded defect rates with the sample size beside them, never a zero-miss promise.

Run a parallel pass on settled files →Read the docs