For MGU Operations

Governance that runs while you work.

The governance work is already happening. Ravon turns it into a permanent, auditable record carriers can see.

Continuous Governance Not Quarterly Reports
Live Governance Feed ● Active
09:14 amSeverity signal: Johnson Group — member at 25% of specNew
09:41 amSarah emailed broker → auto-deferred 7 daysSealed
10:15 amVelocity alert: Martinez Corp — $15K/mo burn rateFlagged
10:22 amThreshold crossed: Apex Industries — 3 members > 40%New
11:05 amAuto-reminder: Chen Holdings — broker follow-up dueQueued
47
Events This Month
100%
Acknowledged < 48hrs
38
Groups Governed
Ravon 2026
01 / 14
The Problem

You know the work happened.
Can you prove it?

Governance has always run on scattered artifacts. When renewal comes, you're rebuilding the narrative from memory. Ravon gives you the record that was never there.
Without Ravon
Spreadsheets, email threads, and phone calls. Nothing connects. Nothing is recorded.
$421K
74%
BREACH
$189K
52%
—
Q3_Claims_Report.xlsx
INBOX — 47 MESSAGES
RE: RE: RE: Follow up on
Riverside Health claims review
Last reply: 3 weeks ago
Call with TPA rep
No record kept
Check with TPA on laser status for Riverside??
— handwritten note
QUARTERLY CADENCE
Next data drop: Q4 2026
90+ DAYS AWAY
No audit trail
With Ravon
Complete, sealed, timestamped. Auto-generated as you work.
Evidence Packet — 9 Sections
Event #247
Signal Detected
Member at 25% of spec — $25K · 09:14 UTC
✓
Action Taken
Broker notified, stop-loss carrier contacted · 09:41 UTC
✓
Follow-up Scheduled
Auto-reminder queued for 7-day check · 09:41 UTC
✓
Record Sealed
Immutable ledger entry · SHA-256 hash · 09:41 UTC
✓
✓ AUDIT-READY
02 / 14
The Market Reality

Catastrophic claims aren't rare events. They're a structural trend.

The data is clear. Severity is accelerating. Monitoring tools haven't changed in a decade.

0
Report $1M+ claims annually
Nearly half of all stop-loss carriers now see seven-figure claims every year
SUN LIFE 2024
0
Increase in $2M+ claims since 2017
Catastrophic claims aren't rare events anymore — they're a structural trend
SUN LIFE 2024
$0
Average top-10 claim charges in 2024
Individual claimants now represent existential risk to entire employer groups
AEGIS RISK 2025
0
Year-over-year increase in $3M+ claims
The severity curve is steepening — not flattening
VOYA 2024
Stop-loss market: $26.9B in 2024, growing at 15.1% CAGR through 2032 VERIFIED MARKET RESEARCH 2024
03 / 14
The Value Chain

Risk flows through a chain
no one governs.

Six handoffs. Zero shared governance trail. When a claim goes wrong, no one can prove who knew what or when they acted.

Capital
Allocation
Reinsurer
Risk Transfer
Carrier
Delegated Authority
RAVON
MGU
Program Stewardship
TPA
Claims & Rx Data
Advisor
Client Relationship
Employer
Plan Sponsor
Vendors
“AI Capabilities”
No Governance Layer
Trust assumed at every handoff. No audit trail, no evidence, no accountability.
Ravon Governance Layer
Signal detection, sealed evidence, and continuous oversight from carrier to employer.
Governing the AI Layer
Ravon adds a validation layer for vendor AI claims via performance monitoring.
stop-loss program governance
04 / 14
The Governance Loop

Every signal generates a prescribed response. The loop closes itself.

Signal Detection
Real-time claimant & program triggers
Configurable Thresholds 5 Layers
Playbook Engine
Your rules, owners & timelines
Rules Conditions Owners
Auto-Actions
Agents + auto-responses
Alert Escalate Email Defer
Vendor Intelligence
Trigger, monitor & track partners
Trigger Monitor Gap Detect
Loop returns → continuous monitoring
Every action → Ledger sealed automatically Evidence Packet always current Carrier-ready on demand
Governance Loop Active
1
Signal detected
Member #4471 at 25% of spec
● Live
2
Playbook matched
High-severity protocol triggered
✓ Fired
3
Auto-action sent
Broker notified + escalation queued
✓ Sent
4
Vendor triggered
Case manager flagged for review
⚑ Flagged
Loop returns → continuous monitoring
All 4 actions sealed to governance ledger
05 / 14
The Intelligence Engine

Configurable signal detection that only surfaces what matters.

Five detection domains. Configurable evaluation gates. A reasoning model purpose-built for stop-loss programs. Only the signals that cross your thresholds become governance events — everything else stays noise.
Engine Output
0claims ingested
0patterns evaluated
0records sealed
Ingest
Evaluate
Deduplicate
Seal & Output
Large Claims
Utilization
Clinical Risk
Specialty Rx
Cost Trends
Dollar Threshold
Diagnosis Match
Concentration
Trend Deviation
Per-Claim Detection
Book-of-Business Intelligence
1
2
3
4
5
6
7
8
Governance Event
HRD Evaluator — catastrophic ICD-10 on arrival
Claimant Velocity — spec breach projected 6 wks out
Permanent Record
Immutable audit entry
Carrier-visible evidence
Ravon Intelligence Engine
06 / 14
Playbook Engine

One signal. One matched rule. The governance chain fires itself.

When a signal fires, Ravon matches it against your playbook library. Owner assigned, timer set, next action queued. Before you open the app.

Unlimited playbooks — per program, signal type, or severity
Configurable triggers: threshold %, velocity, diagnosis code, or any combination
Every action sealed — timestamped and carrier-visible
Signal Detected
Member #4471 · 25% of $100K spec · Hemophilia A (D66) confirmed
HIGH SEVERITY
Playbook Library — matching…
High-Severity Claimant Protocol
Threshold > 60% + Catastrophic Dx · Severity: Critical
✓ MATCHED
Standard Velocity Alert
Threshold 25–60% + Velocity + No Catastrophic Dx
no match
Protocol Fired — Action Chain
Step 1
Auto-assign owner
Sarah Chen · immediate
Step 2
Notify broker
Email + in-app · Day 0
Step 3
Timer + follow-up
7-day window · auto-resurface
Sealed
Ledger Record
Carrier-visible · immutable
Configurable per program Unlimited rules
07 / 14
Auto-Actions · AI Agents

Three tiers. One response system.

Ravon executes the full governance response. Escalation chains, vendor triggers, carrier notifications. All automated, all timestamped, all sealed.

Each playbook defines which tier fires and when
Human-in-the-loop by design — override any action with one click
Every agent action sealed as a governance record
T1
Notify
Instant alerts to governance owners, brokers, and stakeholders. Fires the moment a signal is confirmed.
In-app alert Email Owner assigned
FIRING
T2
Escalate
Multi-step escalation chains with configurable timers. If no response in 48 hours, the next action fires automatically.
Timer chain Defer Re-assign
QUEUED
T3
Govern
Full case management dispatch. Vendor triggers, carrier notifications, TPA coordination. The entire response loop governed and sealed.
Vendor trigger Carrier notify Ledger seal
SEALED
Human-in-the-loop Every action timestamped
08 / 14
Vendor Intelligence

Signals that hold your vendors to account.

Set the thresholds. Ravon watches for the drift. You get alerted before it becomes a claims problem.

Preset criteria fire automatically. No manual monitoring required.
Custom thresholds per vendor. You define what triggers an alert.
Point solution performance scored every reporting cycle.
RAVON MONITORING Telehealth 91% eng CKD Mgmt 34% eng Diabetes 78% eng Case Mgmt WATCH Specialty Rx 85% eng SIGNAL DETECTED CKD Management Engagement: 34% vs 60% threshold breach · signal fired Playbook fired · Event logged GOVERNANCE DISPATCH Escalation triggered Owner assigned · 7-day timer Response sealed to record
CONTINUOUS MONITORING · 5 VENDORS
09 / 14
How Ravon Works

You click "notify broker." Ravon builds the governance trail.

One email. One note. A configurable playbook fires. Owner assigned, timer set, next action queued. It resurfaces with full context when the timer fires.

0 actions by you
0 records by the system
0 total governance records — sealed
app.ravon.io / governance / event-247
Member at 25% of Spec — Johnson Group — 12-Day Sequence  ·  5-state lifecycle: open → acknowledged → deferred → escalated → resolved
Signal: member at $25K of $100K spec (25%)
System · Day 0 · 09:14 AM
Auto-assigned to Sarah Chen (Governance Analyst)
System · Day 0 · 09:14 AM
Sarah emails broker with claim context
You · Day 0 · 09:41 AM
Auto-defer: event paused 7 days pending response
System · Auto
Next step queued: "Request updated diagnosis from TPA"
System · Auto
Auto-reminder fires at Day 7 with full context
System · Scheduled
Sarah adds note: broker confirmed stop-loss carrier notified
You · Day 8
7 governance records sealed — carrier-ready
Complete · Day 12
10 / 14
Ravon Copilot

Your program data, finally answerable.

Ask any question about your book. Signals, claimants, open actions. Answers sourced directly from your program data.

Natural language queries on any signal, claimant, or open action
Every answer grounded in your actual program data
Surface what needs attention before it surfaces on a claim
Ravon Copilot
Connected to your program data
Which claimants are on track to breach spec before renewal?
3 members are projected to exceed spec before Dec 31. Member #4421 is highest risk — $40K of $100K used with accelerating burn rate of $15K/mo.
What's the open action on #4421?
Laser lasered at $80K — notified Mar 12. Evidence sealed. No open actions required.
Ask anything about your book…
11 / 14
The Renewal Conversation

This is what carriers see.

Not a retrospective rationale. Not documentation scrambled at renewal. A continuous governance record that was built while you worked.

0
governance events this policy year
100%
Acknowledged < 48hrs
0
Unresolved Events
Carrier Renewal View — Simulated
Governance Summary — Johnson Group ● Policy Year Complete
Mar 14 Severity signal at 25% of spec — broker notified same day RESOLVED
Apr 02 Velocity alert: $15K/mo burn rate flagged — TPA contacted RESOLVED
May 18 Second member crossed 40% threshold — escalation documented RESOLVED
Jul 09 Rx spend acceleration detected — clinical review initiated RESOLVED
Sep 22 Renewal readiness review — all events documented, 0 open COMPLETE
Every signal detected. Every response documented. Every timeline met.
"That's the renewal conversation Ravon gives you. Not 'we think we handled it.' Here's the timestamped proof."
12 / 14
Getting Started

What Ravon changes. What it doesn't.

Ravon doesn't replace your TPA. It doesn't change your workflow. The governance work you already do becomes permanent, auditable, and carrier-ready.

What Changes
Signals arrive the day they happen. Not quarterly.
Your thresholds. Your rules. Per group.
Every action becomes a sealed governance record
Renewal prep takes hours instead of weeks
What Doesn't Change
Your TPA relationship stays the same
Your team works the way they work
Your carrier reporting stays intact
No new data entry. Governance happens around you.
Week 1–2
Connect claims data
Week 3–4
Configure thresholds + roles
Week 5+
Governance running
13 / 14
The Payoff

Better stewardship
earns more from carriers.

Earlier detection means lower loss ratios. Lower loss ratios mean better renewal terms and more authority. That's the economics of governance.

More authority allocated
Carriers grant more authority to MGUs who can prove consistent stewardship
Lower loss ratios at renewal
Earlier intervention on high-severity claims reduces aggregate exposure before renewal
Fewer restrictions at renewal
Governance proof reduces carrier risk perception — fewer lasers, broader terms
See it with your own data.
A live demo built around your actual claims data. The real product, your real numbers.
Benjamin Prinzing
benjamin@ravon.co
20 years in employee benefits and stop-loss.
Built Ravon because the governance layer didn't exist.
2
User actions
7
Sealed records
Week 1–2 to first signal
Time to live governance
Ravon 2026
14 / 14