Insurance Claims Can Be Simple! Launch of the First AI Claims Agent, ClaimMaster Based on mind42.ai

“Every time I prepare claims documents, I have to go to the hospital multiple times”, “I have to upload the materials over and over again after categorizing them”, “I don’t understand the insurance terms and don’t know how much I can claim”. In traditional claims scenarios, users often face multiple challenges. On one hand, the process of submitting materials is overly complicated, time-consuming, and labor-intensive. On the other hand, the professional terminology in the insurance terms and the underlying logic of the treatment process can be difficult for non-professionals to understand.

These insurance claim challenges that have troubled millions of patients have now found a breakthrough. On April 29, 2025, MediTrust Health, based on the mind42.ai large model platform, officially launched ClaimMaster, the first AI claims agent in the medical payment sector, targeting the three core pain points in traditional claims scenarios: inefficient material handling, crude disease analysis, and delayed clause interpretation. ClaimMaster provides a powerful solution to speed up the claims process for specialty drug claims.

Previously, the user claims process required manually categorizing and uploading various documents such as medical invoices, prescriptions, and medical records. Missing or incorrect document submissions were common, making the process cumbersome, time-consuming, and prone to errors. Incorrectly entered data would result in returned documents, further delaying the claims process and impacting the overall experience.

To address this, ClaimMaster introduces an innovative multimodal parsing engine, breaking the limitations of traditional document processing by enabling efficient and accurate data collection and conversion, thus providing a solid data foundation for subsequent claims handling:

Traditional commercial insurance claims risk management highly relies on manual experience, leading to issues such as delayed rules and blind spots in audits. Risks such as fraudulent materials, abnormal expenses, and concealment of pre-existing conditions are difficult to identify in time, resulting in frequent insurance fraud incidents.

ClaimMaster innovatively builds a multi-dimensional intelligent risk control system that integrates deep learning, big data analysis, and industry rules. The system creates a dynamic defense network throughout the entire claims process, enabling early identification, early warning, and early interception, leaving no room for risks to evade detection:

In traditional claims review models, the materials submitted by users are often fragmented, making it difficult to present the full progression of the disease. As a result, insurance companies can only rely on retrospective validation to assess treatment efficacy and the reasonableness of costs, leading to frequent claims disputes. Additionally, when faced with complex professional insurance terms and drug instructions, patients often struggle to understand the relationship between treatment pathways and claims logic, leading to misaligned expectations regarding claims and eroding trust in commercial health insurance among users.

ClaimMaster, leveraging Deepseek’s natural language processing capabilities and a comprehensive professional knowledge base, acts as an intelligent claims expert that understands both insurance and medicine. It not only converts complex medical logic into a visual medical treatment chain, but also enables rapid reading and analysis of intricate insurance terms, drug indications, and claims guidelines. The system outputs intelligent audit results, allowing both insurers and users to achieve “clear, understandable, accurate, and fair claims”.

ClaimMaster covers 500+ specialty drug indications and clinical pathways. By integrating user medical timelines, medication records, efficacy indicators, and other data, it models the treatment process, transforming complex medical logic into a dynamic 3D medical treatment chain. This chain supports an in-depth view of medication plans, diagnostic indicators, and efficacy at each treatment stage, automatically generating a visualized medical treatment map to dynamically present treatment progress. This makes complex medical treatments easy to understand at a glance.

ClaimMaster can deconstruct complex insurance clauses within seconds and output clear and easy-to-understand interpretations. Based on the actual treatment logic of the patient, it cross-references deductibles, reimbursement rates, and other claims rules, intelligently outputting the claim result. This helps users understand the claims logic and enables insurance companies to precisely calculate claim amounts, effectively avoiding disputes.

From the user’s perspective, in traditional claims processes, users often face the pressure of paying medical expenses upfront, which not only imposes a heavy financial burden but also requires them to organize and submit complex claims materials. If the materials are incomplete or contain errors, the user faces the cumbersome process of multiple submissions and corrections, severely affecting both claims timeliness and user experience. With the Care2Pay™ platform, ClaimMaster deeply integrates AI-driven audits and a comprehensive medical network, reconstructing the claims payment process to create a seamless “treatment and instant claims” cycle. This system enables users to receive immediate claims processing while seeking care, providing a fully integrated experience from medical treatment to claims reimbursement.

Chen Liang, Head of Innovation R&D at MediTrust Health, stated: “At its core, ClaimMaster is about using technology to break down the data silos between healthcare and insurance—shifting risk control from reactive ‘damage control’ to proactive ‘risk prediction’. By building a dual-core knowledge system combining medical and insurance expertise, we enable AI to not only interpret medical images from CT reports, but also understand the technical language of insurance clauses—truly achieving a two-way breakthrough in claims services.”

As the first intelligent agent developed on the mind42.ai platform, ClaimMaster integrates four core capabilities—Smart Collection, Smart Risk Control, Smart Calculation, and Smart Payment—redefining the standard for commercial insurance claims services. From automated material submission and intelligent risk management, to precision claims calculation and seamless payment processing, ClaimMaster breaks through traditional pain points and disconnects in the claims process. It marks a shift from post-treatment reimbursement to front-end service enablement, positioning commercial insurance as a critical pillar in users’ long-term health management.