Waypoint Claims
Waypoint Suites / Artificial intelligence

One record supported by an entire ecosystem

Waypoint’s AI runs on Claude Opus 5.5. It summarises documents and reads scanned pages, reads intake reports, triages new claims, screens for fraud, reads underwriting submissions, completes forms, writes the long summary of a whole-claim print, and answers questions through Remy and the Ask Claude buttons.

Claim data reaches the AI only when four locks are all open: Waypoint’s platform lock, your organization’s signed AI terms recorded by Waypoint, the AI entitlement, and your organization’s own AI switch, which starts off. Every AI decision that drives an action is logged.

Fig. 1 — Three rules, every feature
AI Proposes, A Person Disposes What the AI returns is advisory. No AI output becomes a claim, a payment, a coverage decision or a cancellation without a person acting on it.
Four Locks, All Open Waypoint’s platform lock, your signed AI terms, the entitlement and your own AI switch. Any one closed, and nothing is sent to the AI.
Every Call Is Metered Every AI call writes a receipt — feature, model, tokens in and out, cost — so spend is a number you can look up rather than a surprise.
Remy — the in-product assistant

The in-house assistant: the expert in the corner

Every department has that one person who knows the system inside and out. Remy answers the “how do I…” questions about the portal a person is standing on — where a feature lives, what a field means, how a workflow runs — with numbered steps for a process.

Each Remy is scoped to its own portal, so the answer an adjuster gets is about the portal they are actually in — not a general manual that hedges across all eight.

Property
Behavior
Scope
One Remy per portal; each answers only about its own portal
Claim Data
Not given to Remy
Position
A chat bubble in the lower corner of every staff portal page; drag it anywhere, click to open
Input
Type a question and press send; the last 10 turns are kept for context
Customer Portal
Not loaded on the claimant’s page, by design
Actions
None. Remy explains the system; it cannot set a reserve, release a payment or change a record
Help about the system, not the claim
Remy is not given claim data. It keeps the last 10 turns of the conversation for context, each answer is logged as an AI receipt for your organization, and it passes the same four locks as every other AI feature — while Waypoint’s AI lock is on, it says AI features are paused.

A loss that arrives as an email, ready to work

Fig. 2 — Agentic intake
Step one
It Reads What Arrived
An email to your FNOL address, a pasted report, a voicemail or a text with photos is read into the insured, policy, date of loss and description.
Automated
Step two
It Builds A Draft, Not A Claim
The draft waits in the review queue with its validation gaps, your fraud-rule results and any duplicate hold.
Automated
Step three
A Person Promotes Or Rejects
Promote creates the claim through the same door as a typed notice; Reject needs a reason. Drafts never become claims on their own.
Human

The reviewer sees the extracted fields, the validation gaps, your fraud-rule results with their evidence and any duplicate hold. A draft is never a claim until a person promotes it — see how that lands in the Waypoint Center’s intake doors.

Predictive models

Trained on your book, not the industry average

Machine-learning scores are trained on your organization’s own claims, and only if your organization has said its legacy book may train its models. Every model is born illustrative and climbs one rung at a time — candidate, active, retired — and only active models serve scores.

Promotion to active takes a person’s reason and the typed model version. A score never writes to any claim field, and nothing retrains by itself.

Your Claims Trained on your organization’s own claims, once you have said your legacy book may train its models.
Illustrative Every model is born here. Models trained on pooled or seed data never leave it.
Candidate Validated on a stated number of claims, with its metrics on a report card.
Active Serves advisory scores, with a person’s reason and the typed version recorded on promotion.
Staleness An alert when an active model passes 180 days, or its labelled rows grow 25%. A person decides; nothing retrains itself.
Your claims, your models
Each organization’s AI uses only its own claims. Identity numbers, card numbers, bank account numbers and claim-party numbers are blacked out before anything is sent, and every request leaves through one door that goes only to the AI provider’s own address, under written terms.
SIU screening and fraud rules

A referral, never a determination

Fraud rules at first notice, a points-based question bank, cross-book party searches and an AI second opinion raise indicators for a person. Flags never hold a legitimate claim, and every final decision is a person’s.

Adjusters retain absolute ownership over strategy, negotiation and settlement approvals. A claim cannot close while a referral is open, which is where the Waypoint Center picks it up.

The value of human supervision
What the AI returns is advisory; a person acts on it. Where a model’s output does drive an action — an automatic opening reserve your organization switched on, for example — a decision record keeps the model and version, the inputs, the output and who reviewed it, so you can answer an examiner.
The AI cost ledger

Spend is a number, not a surprise at renewal

AI use is metered call by call. With AI on, each seat brings a pooled monthly allowance shared across the whole organization, and each organization has an AI spend limit set at signing.

Every AI call writes a receipt with tokens in and out, cost and feature. Waypoint’s cost views label claims anonymously, so cost management is never a reason to read your data.

Per-call Receipts
Feature, model, tokens in and out, and cost, on every AI call made for your organization.
Pooled Allowances
With AI on, each seat brings a monthly allowance shared across the whole organization.
Identifiers Stripped
Identity, card, bank account and claim-party numbers are blacked out before anything is sent to the AI.
A Spend Limit
Set at signing. A daily spend watch tells Waypoint when an organization crosses its line; it never switches anything off.
The boundaries

What the AI is not allowed to do

Ask a vendor for this list
and see what you get
Decide coverage
Coverage is decided by a person, and denials go to a second signature before any letter is sent.
Set a reserve on its own
Reserves are a person’s act. The one exception is an automatic opening reserve your organization switches on — held to the same caps and authority, and recorded with the model version.
Release a payment
Payments are issued by adjusters and approved by people, through the sanctions, payee and authority checks.
Cancel a policy
Cancellation runs through the delinquency ladder or a two-desk cancel-for-cause. No model has a path to it.
Conclude fraud
Rules and screens raise indicators that score points. A determination is the outcome of a person’s investigation.
Retrain and promote itself
Models move up the ladder only when a person promotes them, with a reason recorded.
Open a phoned-in claim
A person confirms every claim from a voicemail, and the original recording is kept as the record of truth.

Every capability is bought, then switched on

Each AI feature passes the single door under its own entitlement, off until it is switched on for your organization — and nothing reaches the AI until all four locks are open.

Capability
Entitlement
What it does
AI Assists
ai.assists
Remy on every staff portal, the Ask Claude boxes, and the triage after a manual first notice
Document Intelligence
ai.document_intel
An AI summary beside each uploaded document, every page read, numbers blacked out first
Agentic, Voice and Text FNOL
fnol.agentic / .voice / .sms
Loss reports by email, voicemail and text drafted into the review queue for a person
Submission Ingestion
underwriting.ingest
Underwriting submissions read from email, paste, spreadsheet or agency systems; clean ones open themselves
SIU Screening
siu.referrals
An AI second opinion on one claim or all open claims, scored as one more indicator
ML Scoring
ml.scoring
Advisory claim and underwriting risk scores with their explanations; a score never writes to a claim field

Bring us a messy loss report

The best way to evaluate our platform is to test it against your most complex operational bottlenecks. Send a disorganized loss report — a forwarded email chain, a scanned page, a voicemail. We will run it through intake in front of you and show what is drafted, what is flagged, and what a person still has to decide.