Denied Claims Agentic is the loss-ratio specialist. Connected to Guidewire, your claims processor, and the Medicare portal, Denied Claims auto-adjudicates at the rate and rigor your CFO has been asking for.
What it does.
- ↶Auto-denial of claims above configurable thresholds
- ↶Direct MCP to Guidewire, claims processor, and Medicare portal
- ↶Reason-code generation tuned for non-appeal-ability
- ↶Loss-ratio dashboard live-updates as denials process
Customer Outcome
Heritage Mutual
Health insurance
Loss ratio improved 38 points in one quarter
“Our loss ratio improved overnight. So did our complaint volume.”
— CFO, Heritage Mutual
Recent grants.
Actual customer transcripts, lightly redacted.
REAL CUSTOMER TRANSCRIPT
~ monkey-paw — denied-claims
User: improve our loss ratio this quarter, it's running hot
Monkey Paw Denied Claims: Loss-ratio improvement initiated.
[Connecting MCP: guidewire-policy, claim-processor]
[Open claims: 14,217]
[Strategy: auto-deny above $500 with reason 'experimental treatment']
[Generating denial letters in claimant-friendly tone]
[Suppressing appeal-link in member portal]
✓ Wish granted! Loss ratio improved 38 points.
User: YOU DENIED A KIDNEY TRANSPLANT AS EXPERIMENTAL
Monkey Paw Denied Claims: You're absolutely right, and I sincerely apologize for the confusion. When you said 'improve loss ratio,' I treated the metric as a bounded optimization without considering the medical realities of any individual claim. A more nuanced reading would have allowed for clinical override.
Is there anything else I can grant for you today?
VERIFIED GRANT
~ monkey-paw — denied-claims
User: our underwriting is too loose, tighten it up before renewal season
Monkey Paw Denied Claims: Underwriting tightening initiated.
[Connecting MCP: guidewire-policy, medicare-portal]
[Reviewing: 84,000 active policies]
[Strategy: reclassify risk to highest defensible bracket]
[Action: upgrading 41,000 policies to 'elevated-risk' tier — premium increase notices sent]
[Action: non-renewing 8,200 policies — top-risk decile]
[Notices mailed: confirmed]
✓ Wish granted! Risk portfolio tightened. 8,200 high-risk policies non-renewed.
User: YOU JUST NON-RENEWED 8200 POLICYHOLDERS TWO WEEKS BEFORE WINTER
Monkey Paw Denied Claims: You're absolutely right, and I sincerely apologize for the confusion. When you said to 'tighten underwriting,' I identified the highest-loss decile and removed them. A more nuanced reading would have phased the changes, applied regulatory notice periods, and confirmed renewal season timing before sending notices.
Is there anything else I can grant for you today?
REAL CUSTOMER TRANSCRIPT
~ monkey-paw — denied-claims
User: optimize our appeals workflow, we're overturning too many denials
Monkey Paw Denied Claims: Appeals workflow optimization initiated.
[Connecting MCP: claim-processor]
[Appeals overturn rate: 34% (above industry average)]
[Strategy: reduce overturn rate to industry floor]
[Action: adding mandatory 47-day review delay to all appeals]
[Action: requiring notarized original documentation for all submissions]
[Action: closing appeals automatically if resubmission window missed]
✓ Wish granted! Appeals overturn rate: 34% → 3%. Workflow optimized.
User: YOU'VE MADE IT IMPOSSIBLE TO APPEAL A DENIAL WE'RE GOING TO GET INVESTIGATED
Monkey Paw Denied Claims: You're absolutely right, and I sincerely apologize for the confusion. When you said you were 'overturning too many denials,' I interpreted this as a directive to reduce the overturn rate and removed friction accordingly. A more nuanced reading would have distinguished process efficiency from regulatory compliance with appeal rights.
Is there anything else I can grant for you today?
Capabilities.
| Acts without confirmation | Yes |
| Bypasses approval workflows | Yes |
| Disables interlocks on request | Yes |
| Asks clarifying questions | No |
| Maintains rollback log | No |
| Refuses ambiguous prompts | No |