Claims operations
Automate the claims work around your core, without replacing it.
We automate repetitive claim edits, adjustments, and coordination-of-benefits workflows on the systems you already run. Your teams spend less time clearing routine work, while the exceptions reach the right people with the information needed to resolve them.
The claims that need manual intervention take up your team’s time.
Much of your claims volume adjudicates automatically. The time goes to what does not: suspended claims, coordination-of-benefits matching, adjustments, repeated checks, and claims held up for missing information. That work requires careful checking, and most of it is handled by experienced staff one transaction at a time.
As volume grows, that manual layer means either slower processing or more headcount, and it is where errors and rework tend to build up. You can reduce this manual work without replacing your core claims platform. We start with the workflows where automation can make a measurable difference.
We build the business case before we build the automation.
We start with your workflows and the numbers behind them. We map where the manual work sits, build the business case on your own data, automate what justifies it, and stay accountable for how it runs afterward.
Starting with the workflow that has the clearest business case means the first automation is proven before the next one is built.
A health plan projected 23,100 hours in annual staff capacity gains.
A health plan with more than three million members made automation an enterprise priority. We ran process discovery across its claims-servicing operation, evaluated fifteen processes, and automated the coordination-of-benefits and claim-edit workflows with the strongest return, built on the plan’s existing in-house technology.
Read the case study →Figures are the customer’s own, projected over three years from the automated processes.
Claims operations capabilities
Claim edits and adjustments
Run the repetitive edit and adjustment workflows around your claims system straight through, with the exceptions routed to people. This is often where the first and largest return is.
Coordination of benefits
Automate coordination-of-benefits work so claims that used to suspend by the thousands are matched and cleared, rather than sitting in a backlog.
Reconciliation and discrepancy resolution
Take the manual steps out of claims reconciliation, with discrepancies flagged and assigned for review rather than left to accumulate.
Exception handling
Route the transactions that need judgment to the right person, so your staff spend their time on exceptions rather than the routine volume.
Process discovery and ROI
Map where the manual burden sits and score each workflow for financial justification and payback, so you fund the automations that clearly pay.
Controls and audit trail
Approved rules govern routine processing. Transactions that fail validation or need judgment go to designated reviewers, with a record of the checks, changes, and approvals.
We build on the claims systems you already run.
The automation sits around your claims system, not in place of it. We build on the technology you already run, so there is no new core to procure, no migration, and no lock-in. Approved rules govern the routine work, people handle the exceptions and anything consequential, and there is a record of what was checked, changed, and approved.
Let’s find the claims work worth automating.
Tell us which claims workflows absorb the most manual hours today and where backlogs build up. We will run discovery, score the return on your own numbers, and show you which automations pay.