For payers
See risk sooner, reach members earlier, and decide faster.
Health plans hold the data to act earlier, across claims, clinical, eligibility, utilization, and member interactions. The time goes to pulling it together and moving it into action. We work alongside your teams to shorten that path, across population and risk, member engagement, care and utilization management, and claims operations, on the systems you already run.
Four parts of one operation, from risk to resolution.
Seeing where risk is forming, reaching the right members, getting the clinical decision made, and resolving the claim are connected. These areas share data and depend on coordinated work across teams. We start with the priority workflow and expand once the results are measured.
We stay accountable for the outcome.
We do not hand over a model and leave. We work alongside your teams: we find where the work slows down, build the fix, and run it with you, on the systems you already run.
Assess
Identify the priority workflow and establish the baseline using your own operational and financial data.
Build
Build the fix alongside your teams, configured to your workflows and integrated with the systems you run.
Run
Operate it with you or hand it over, and measure the result against the baseline you started from.
We measure results before expanding to the next area. See how we work →
AI proposes. Checks verify. A person decides.
The concern most risk and compliance teams raise about AI is what it can do on its own. Our answer is built into how the work runs.
Models surface who needs attention and what the action is, drafting but never committing on their own.
Defined rules check eligibility, benefit requirements, policy criteria, and required documentation. Cases requiring clinical judgment go to authorized reviewers.
A person approves anything consequential, and every step is recorded, so the work stays auditable.
Underneath all of it, the Data & AI foundation: one governed view of your operation, with AI outputs checked against defined rules and people approving consequential decisions. If you are building your own AI capability, our AI Center of Excellence helps you assess, govern, and deploy it.
Results from across the payer operation.
Our prior-authorization and claims engagements show the approach in production.
Figures are each customer’s own, from one engagement, attributed on its solution page. Projections are noted where they apply.
Which part of the operation is costing you the most?
Tell us which workflows are delayed or require too much manual effort. We will help quantify it and show you where to start.