What

Adaptional is an AI-powered continuous claims review platform for insurance organizations. It is designed to audit 100% of claims files, using claims data, notes, and documents to identify compliance gaps, leakage, reserve issues, and other file-level problems while claims are still open.

The product appears positioned as an alternative to manual claims QA and limited sample-based file reviews. Its workflow centers on connecting to a claims system, configuring an audit scorecard, and continuously reviewing every claim in real time so managers can detect issues earlier and intervene before they become larger operational or financial problems.

Features

Continuous claim auditing — Reviews every claim against defined audit criteria in real time rather than relying on periodic manual sampling.
Claims system data ingestion — Pulls in files, notes, and documents from Guidewire, Duck Creek, or other systems to evaluate claims within existing operational environments.
Custom audit scorecards — Lets teams define review criteria around compliance, coverage, reserves, leakage, service quality, and subrogation so audits reflect internal priorities.
Open-file issue alerts — Surfaces problems while claims are still active and enables managers to monitor whether corrective actions are completed.
Six-dimension claims evaluation — Assesses files across concrete areas including deadlines, policy coverage decisions, overpayments, service quality, recovery opportunities, and reserve adequacy.
Fast deployment approach — The site states the product can be up and running in days and claims no integration project is required, which suggests relatively lightweight implementation.

Helpful Tips

Validate scorecard design early — The value of continuous auditing depends heavily on how well audit criteria reflect your claims philosophy, escalation rules, and regulatory priorities.
Start with high-cost failure modes — Reserve accuracy, leakage, coverage decisions, and missed compliance deadlines are practical first areas to test because they have direct financial and operational impact.
Plan manager workflows, not just alerts — Continuous review only improves outcomes if supervisors have clear processes for triage, remediation, and follow-up on flagged files.
Compare outputs against current QA results — During evaluation, use a sample period to see whether the platform finds issues your existing sampling process misses and whether findings are actionable.
Clarify system and document readiness — Since the product depends on ingesting claims data and documents, buyers should confirm source data quality, file completeness, and note consistency before rollout.