Inside the Buyer’s Guide to Claims Documentation Platforms: Security and Compliance Primers

Claims documentation platforms (CDPs) need to be easy to use and efficient in order to bring value to your firm. However, that doesn’t mean you should sacrifice security and compliance. Enterprise organizations need to deliver high quality professional services, which can be automated quickly with AI. For claims teams, though, the questions of features and price should be well-balanced with compliance and security controls. Your customers and clients trust you with their sensitive medical claims documents, many of which contain protected health information (PHI). 

In the 2025 survey commissioned by Wisedocs and conducted by ALM PropertyCasualty360, 49% of claims professionals identified compliance and regulatory risk as one of the top challenges when integrating AI into their claims document review. With healthcare data so sensitive that even location can cause re-identification, it’s essential for AI systems to be built ethically, trained appropriately, and supported by human-in-the-loop oversight.  

Essential Requirements for Security and Compliance

Whether you build or you buy, dealing with sensitive PHI means keeping on top of compliance. Before you choose your CDP option, keep in mind: 

• Compliance, legal, and governance obligations: non-negotiable obligations include HIPAA compliance, a Business Associate Agreement (BAA) with appropriate terms, and privacy protection of PHI at all stages.
• Where the data processed and stored: have the platform’s security, availability, processing integrity, confidentiality, and privacy controls been validated, and when was the last SOC 2 audit conducted? Were there any findings? Where is your data hosted and stored, and does it comply with the privacy laws in your region? 
• Access controls: how granular (and flexible) are the access controls, and are permissions in place to protect the most sensitive patient data? Is data partitioned from other clients and kept secure? 
• Logs: which user activities are logged, and how can you monitor security or compliance oversight?

Additional security requirements to consider include penetration testing, data retention policies, human-in-the-loop processes and the introduction of trained experts, multi-factor authentication, and backups. 

Claims Teams Need Optimal Security and Compliance

IT decision makers need to look at how the model is trained, including asking whether it operates on real, industry-specific medical or insurance documentation versus generic data. They should also look for a platform with safeguards designed to prevent hallucination. In an enterprise claims organization, a compliant, human validated CDP is a must. Human-in-the-loop should be a core part of your workflow, especially for sensitive data like PHI to ensure data is reviewed responsibly, securely, and with the oversight required for high-stakes claims.

An ethically, sustainably built platform should look at how the work is done – not just its core pricing or features. Keeping on top of compliance is a big deal if you’ve bought into an “end-to-end AI solution” that relies solely on a third-party model with no domain-trained algorithms behind it—leaving you exposed to accuracy gaps, regulatory risk, and outputs you can’t fully validate. With an industry as sensitive as claims and legal, a platform that under-delivers on the oversight mechanisms that prevent privacy breaches, security vulnerabilities, or re-identification can open up your organization to a lot of unnecessary exposure. 

In an industry built on preventing risk, insurance companies and claims organizations must protect their reputation and remain compliant. Ethical, domain-trained AI, human validated oversight, and enterprise level security make for a secure AI experience – without sacrificing any of the efficiency possible with an AI platform. 

To learn more, check out the Wisedocs 2025 Buyer’s Guide for more details on finding a Claims Documentation Platform to fit your needs.