Claims and coverage answers your policyholders can trust — and your regulators can retrace.
Palladium gives carriers a self-service concierge for claims status, coverage questions, and underwriting eligibility — every answer traced back to a policy record or a decision rule, never to a model's guess.
Trusted by 300+ client organizations
Policyholders want self-service. Regulators want a paper trail for every one of those answers.
Insurers face a narrower margin for error than most industries adopting conversational AI. A claims denial explanation, a coverage determination, or an eligibility answer isn't just customer service — it's a statement about a contractual obligation, made in a market that state insurance commissioners actively supervise. NAIC model laws increasingly expect carriers to document how automated tools reach consumer-facing outcomes, and any AI system touching policyholder data has to hold up against GDPR and CCPA obligations at the same time. A chatbot that "sounds confident" isn't good enough when the underlying question is whether a claim was adjudicated correctly. Palladium's architecture is built for exactly this: the deterministic core reads the actual policy and claim records and decides first, and the model's only job is to explain that decision in plain language — never to reason its way to a coverage answer on its own.
Four everyday moments, fully self-service.
Claims status inquiries
Policyholders get a real-time claim status pulled straight from the claims system — not a generic "your claim is in review."
Coverage & policy questions
"Am I covered for this?" is answered against the actual policy document and endorsements, with the applicable clause cited.
Underwriting eligibility
Applicants get a deterministic eligibility read against underwriting rules, with ambiguous cases routed to an underwriter.
First-notice-of-loss triage
FNOL intake is structured and routed automatically, with severity and urgency flags handed to the adjuster queue.
Partners
Two conversations, the same architecture underneath.
Concierge never adjudicates a claim or interprets ambiguous policy language on its own. It retrieves the determination a deterministic system already made and explains it — or it recognizes when a question needs a licensed human and hands it off cleanly.
- Core system pulls the claim decision record and the applicable policy clause
- Concierge explains the denial reason in plain language
- Offers a clear appeal path
- Concierge checks policy terms deterministically
- Explains coverage and any applicable deductible
- Flags genuinely ambiguous cases for a licensed agent
Every claims answer replays back to the record that produced it.
The same five-step path that runs across every Palladium deployment applies here: policyholder data is masked before it reaches a model, the deterministic core reads the claim and policy records to decide, the model narrates that decision, and a sealed, replayable record is available the moment an examiner, auditor, or state regulator asks for it. Nothing about a claims denial or coverage determination is ever "explained" by the model reasoning on its own — it is always retrieved and narrated.
- Deterministic core decides claim & coverage outcomes
- Model only narrates — never adjudicates
- Replayable audit trail for every interaction
- Automatic handoff on ambiguous or high-stakes questions
Built for the frameworks your regulator already recognizes.
Insurance sits at the intersection of state-level insurance regulation, national model laws, and data-privacy regimes governing policyholder information. Palladium's architecture maps to each without requiring a different product for every jurisdiction.
| Domain | Representative frameworks | What Palladium maps to it |
|---|---|---|
| State insurance regulation | State insurance commissioner requirements · NAIC model laws | Documented, retraceable logic behind every consumer-facing claims and coverage determination. |
| Data protection & privacy | GDPR · CCPA/CPRA | Consent management, PII redaction before model access, data residency controls for policyholder data. |
| AI-specific regulation | EU AI Act | Risk classification, explainability, and human-oversight requirements for high-risk consumer-facing use. |
See the complete framework mapping, including banking- and healthcare-adjacent regimes that carriers with broader financial-services operations also need, on the Platform page.
See it on your own claims and policy data
Walk through a real claims-status or coverage conversation on your own portal design — no live policyholder data required.