Let agents settle claims. Never above anyone’s authority.
Agents can read the file, propose the settlement and pay the small ones in minutes. TraceMem holds every payment to the authority your handlers already work to, and sends anything above it to the one person who can sign it off.
Regulators are already asking how claims get decided.
Some of these already apply and some are still coming. Between them they ask how automated decisions were made, who was accountable and where the data went, and only a record kept at the time can answer.
31 Jul 2023 · UK
The Consumer Duty applies
Insurers must show their customers get good outcomes, claims handling included, whoever or whatever handled the claim.
A utilization review agent may not use an automated decision system to make an adverse determination, wholly or partly. It reaches health plans issued or renewed from 1 Jan 2026.
Under the Data (Use and Access) Act, significant automated decisions taken from this date need safeguards: telling the person, human review on request, a right to contest.
Dates checked against each regulator’s own publication, September 2026. Not legal advice.
Automated decisions at insurers already have a file with regulators.
None of these involved an AI agent. Each was a system acting for an insurer, and each came down to decisions nobody could account for, or data that went where it should not.
Mobile phone claims and complaints were handled on its behalf by a third-party administrator, and some claims were unfairly declined or not investigated adequately.
What it came down to
Claims decided in its name, without the oversight to see how they were decided.
For an agent, with TraceMem
Every action an agent takes on your behalf names who it acted for, the rule that applied and who decided.
Its denial rate on prior authorization requests for post-acute care rose from 8.7% in 2019 to 22.7% in 2022, as it used an algorithm-driven review tool. Lawsuits over the tool are pending, and their claims are allegations.
What it came down to
Coverage decisions shaped by an algorithm, with a person's part in each one hard to show.
For an agent, with TraceMem
Above the limits you set, an agent cannot decide. One named person does, and the record says who.
Every month you wait, agents handle claims nobody can account for.
Put in your own numbers. What your agents read and paid before a governed path is in place can never be recorded afterwards.
100
6 months
21 working days a month. Your numbers stay in your browser.
In 6 months of waiting
100,800
Agent actions with no record of what they read, what the model saw or who signed them off.
Next 18 monthsNo recordOn file
Settle the first claim on the record this month.
Pick whichever is quickest for you. However you get in touch, a person replies. With our forward-deployed engineers, TraceMem can be running inside your network in days.
Free for 45 days on our Docker-based trial image, inside your own network. When you are ready, it upgrades to the full enterprise product.
Forward-deployed engineers, ours or our partners', can set it up in days and help you define policies and integrations. This may be charged separately.