This looks like Bad Dudes from NES.

So basically, it reads - we hate Tom, he's a monster asshole. Tom owns this car. We will pull this car over, apprehend Tom and beat his ass. However, we know Tom rarely drives said car, but we will pull it over anyway and beat the shit out of the driver as the driver is Tom by default. No?

I think Couchfuck McGee is a fantastic nickname.

This was how it worked before AI. Claims run through software that contain coverage logic based on the benefit guidelines for that particular insurance plan. AI is the same thing, it's just the new term for software that uses logic to decide an action.

Salary/pay rates would need to compensate for that level of risk and required education. Instead, medical boards create criteria and guidelines for coverage. Software logic reviews claims and passes or fails based on that set criteria.

Not necessarily. Theres fifferent levels of denials, some are medical and some are data driven. Theres no insurance company in the US that employs enough doctors to have every denial reviewed. I believe the only time a claim is reviewed by a doctor or certified medical personnel is upon appeal.