Hypermodel
Workers' compBook a demo

Use case · Workers' comp

Claims audit and quality assurance

Traditional QA reviews 3–5 files per adjuster each quarter — under 5% of the book. Hypermodel reviews every open claim against your service standards, continuously, with examiner-level drill-down.

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Dimensions

Built for workers' comp

Workers'-comp-specific checks, not a multiline tool adapted to comp.

FROI / SROI clocks

Statutory reporting deadlines tracked per claim, per jurisdiction.

Three-point contact

Whether the injured worker, employer, and provider were contacted on time.

Reserve adequacy

Reserves flagged when they drift from exposure, before they go stale.

No activity in 90 days

Dormant files surfaced for review.

Duplicate payments

Overpayments and duplicates identified across the book.

Missed subrogation

Recovery opportunities flagged before the window closes.

Coverage

Every claim vs. a quarterly sample

Sample QA

3–5 files per adjuster per quarter (under 5%)
Retrospective — after the file has closed
Covers only what lands in the sample
Findings tracked in spreadsheets

Hypermodel

Every open claim, reviewed continuously
Surfaces issues while the file is still open
Leakage, reserve drift, and missed deadlines across the book
Explainable audit trail

Governance

An explainable audit trail.

Each flag shows its reasoning and the underlying claim evidence.
Scored against your service standards, not a generic template.
Examiners review and act; the system supports their work rather than replacing it.
A complete record of what was scored, when, and why — for QA and compliance.

Claim-handling QA, not medical-coding audit

Hypermodel audits how claims are handled against your service standards. It is separate from medical-coding and bill-review audit (CPT/ICD recoding or fraud-waste-abuse coding review) — a different problem handled by different tools.

Run it on your files

Your files. Our scorecard.

Send a sample of claim files and we'll return a service-standard scorecard — or book a full walkthrough.