Insurance Claims Analytics

Insurance claims analytics is a solution that transforms raw claims data into actionable business insights for insurance companies by leveraging machine learning, predictive modeling, and real-time data processing to identify fraud patterns, optimize claims processing workflows, predict claim costs, and improve risk assessment accuracy.
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Springbuk

Springbuk

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3,000,000

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Springbuk Health Intelligence is built on a foundation of scalable data automation. We have standard data models to support data integration across all types of employee benefit programs - from claims and eligibility... Show More
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Mede Analytics

Mede Analytics

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About Mede Analytics

With over 30 years in the industry, MedeAnalytics is a leader in healthcare analytics. Using a data fabric enabled cloud platform, our SaaS solutions run on cutting-edge innovation and enable measurable impact for healthcare payers, providers and payviders. With the most advanced data orchestration and interoperability in healthcare, organizations count on us to deliver actionable insights that improve financial, operational and clinical outcomes. To date, we’ve helped uncover millions of dollars in savings annually. Show More
Wellnecity

Wellnecity

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2,500 eligible

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330,000

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Wellnecity's Smart Hub transforms your self-funded health plan into a high-performing asset by effortlessly integrating key vendors and various point solutions, ensuring transparency and accountability.

Wellnecity’s Smart Hub integrates member-level... Show More
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Dart Health

Dart Health

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Founded

06/2022

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0

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About Dart Health

Dart Health exists to connect healthcare benefits businesses to employee data for eligibility, claims, programs, enrollments, and more.

We shorten employer data onboarding timelines, and lower the total operating cost for any service provider. Our Data Nexus is a scalable, enterprise-capable SaaS solution that receives and processes data from flat files, CSVs, APIs, and more with error handling built in, designed specifically for the employer health and benefits market.

Never again ask "what is your data file format?" Don’t get trapped in the data engineering business. That’s our job. Show More
Cotiviti

Cotiviti

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Founded

2004

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8,573

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About Cotiviti

Cotiviti is a leading solutions and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value. Cotiviti’s solutions are a critical foundation for healthcare payers in their mission to lower healthcare costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, and network performance management programs. The company also supports the retail industry with data management and audit services that improve business outcomes. Show More
Budgie Health Inc.

Budgie Health Inc.

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200,000

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Use our underlying analytics engine to model endless plan design and contribution scenarios and evaluate the employee-level financial impact. Show More
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Meeko Health

Meeko Health

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Founded

2023

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0

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1.9M Seed Round

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About Meeko Health

Meeko is shaping the future of how we think about treating mental health. Meeko is an employer sponsored benefit that allows employees access to root cause focused mental health care using FDA approved Psychedelic-assisted therapy.

Our licensed provider network is available nationwide for in-person integrative mental health care which is accessible through our portal with support from a care navigator. Our app and platform are designed for the best outcomes tracking to be sure members receive top behavioral health results for their wellness so companies profit on a productive team. As a brand, we focus on educational... Show More
Nayya

Nayya

4.7 (5)
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Founded

2019

Employees

130

Funding Summary

105.7M Series C

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About Nayya

The New Era in Employee Benefits.
Inspired by the end-employee. Powered by data. Join us in revolutionizing the way consumers experience group benefits.

Nayya drives benefits impact from enrollment to usage to re-enrollment. Nayya delivers on this impact through:
- Data infused personalization — bringing together data in order to surface hyper-relevant guidance at scale
- Optimized benefits spend — holistic solutions that balances healthcare needs and value with financial affordability
- Digital engagement expertise — drive ultimate benefit impact through intuitive, timely member experiences

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Garner Health

Garner Health

5.0 (1)
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50 eligible

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-

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Finally, a platform that solves the challenge of delivering accurate and comprehensive provider referrals. Garner DataPro serves referrals based on the most detailed provider performance and directory data in the industry.
By... Show More
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Sedgwick

Sedgwick

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Founded

1969

Employees

33,000

Funding Summary

4B Angel Round

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About Sedgwick

Sedgwick brings comprehensive claims and productivity management solutions to a wide range of American businesses, from local employers to global corporations with U.S. roots. We offer the broadest array of integrated services available in the industry, delivered by our experienced, knowledgeable and dedicated colleagues in 80 countries around the globe. From our humble beginnings as a regional TPA in 1971, Sedgwick has grown to more than 33,000 professionals meeting the needs of North American businesses.
Our operational structure is divided into regional business units to ensure that each program is supported strategically by a senior-level management resource. Each... Show More
Verifi1

Verifi1

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15,000

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Our Medical and Pharma Claims Process uses AI technology to review claims, learn patterns in claims files and develop responses to help employers reduce their retrospective claims expense. We can also review claims... Show More
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Reclaim Health

Reclaim Health

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1,000 eligible

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1,500,000

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Reclaim’s AI-powered, claims-driven healthcare financial advocacy solution delivers year-round monitoring of all claims (small and large) and provides human supported proactive financial advocacy, claims-driven benefits recommendations, and robust claims data analytics.
... Show More
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Wellworks For You

Wellworks For You

4.1 (43)
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100 eligible

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250,000

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Wellworks For You integrates medical and pharmacy claims data into our analytics platform to provide a complete view of population health and cost drivers. By identifying high-cost conditions, care gaps, and utilization patterns,... Show More
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Amaze Health

Amaze Health

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Founded

2019

Employees

85

Funding Summary

5M Seed Round

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About Amaze Health

Amaze provides education, tools and resources, including a world-class virtual medical service that ensures every American has their own independent medical partner. Our motto is One Partner, One Platform, One Name to Trust because we combine everything from telemedicine to EAP, workplace injury triage, mental health, and wellness into a single platform with a single partner that's always available and easy to access. The result is lower costs, better care, and an Amazing experience. Show More
Benefitfocus

Benefitfocus

3.8 (3)
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1,000 eligible

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-

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Integrated benefit claims data for analytics to help shape, manage and measure benefit strategy. Includes services to identify claim errors and recover overpayments on behalf of the plan sponsor. Show More
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BMI Audit Services is now Lumelight

BMI Audit Services is now Lumelight

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100 eligible

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1,000,000,000

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BMI's medical and pharmacy claims audit services are designed to uncover what dollars are being spent on for self-insured benefits plans. Our processes provide a detailed review of claims data to confirm that... Show More
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Innovu

Innovu

3.6 (1)
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Founded

2014

Employees

85

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About Innovu

Innovu is dedicated to helping advisors and their clients stay ahead of the curve regarding benefits strategy. Our SAAS platform and comprehensive menu of targeted solutions have been thoughtfully designed to help you optimize human capital risk management, health benefit design, and procurement through fully integrated claims data, predictive analytics, and health information insights. With Innovu, you'll not only be able to drive savings opportunities for your clients, but you'll also be able to provide financial reporting and tools for plan sponsors to adhere to the Consolidated Appropriations Act. Additionally, you can dive deep into the available data through the... Show More
Benefits Claims Intelligence LLC

Benefits Claims Intelligence LLC

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Founded

2019

Employees

4

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About Benefits Claims Intelligence LLC

At BCI, we provide intelligent healthcare claims analysis. We identify cases of waste, fraud and abuse by utilizing advanced technology to analyze millions of healthcare records. We then assist healthcare plans in recovering misused plan funds, achieving fiduciary compliance, lowering costs and mitigating risk.

Our mission is to become the recognized leader in healthcare claims and fiduciary analysis, ERISA compliance, asset recovery, and risk mitigation.
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PlanYear

PlanYear

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Founded

2022

Employees

13,000

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About PlanYear

PlanYear is a comprehensive benefits solution built for benefits consultants, employers and employees throughout the benefits lifecycle. We help benefits consultants scale their workflows, empower employers to make their mark, and elevate employee experience. Show More
The Rawlings Group

The Rawlings Group

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Founded

March 1977

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0

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About The Rawlings Group

Developed first outsourced subrogation program for health payers. For 45+ years Rawlings has delivered more value for clients than any competitor through service excellence, recovery expertise, quality, and innovation. Show More

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Frequently Asked Questions

What is Insurance Claims Analytics?

Insurance claims analytics is a data analytics platform that uses machine learning and predictive modeling to analyze claims data, detect fraud, optimize processing workflows, and provide actionable insights to improve insurance operations.

What Types of Fraud can the System detect?

These platforms usually identify various fraud patterns including staged accidents, inflated medical bills, duplicate claims, identity theft, provider fraud, and suspicious billing patterns through automated anomaly detection and machine learning algorithms.

What Data Sources does the Platform integrate with?

These tools integrate with core insurance systems, medical databases, third-party data providers, government databases, and external fraud detection networks to provide comprehensive analysis.

Are these Solutions compliant with Regulatory Requirements?

Yes, these solutions include built-in compliance reporting for HIPAA, state insurance regulations, and other relevant standards, with audit trails and data governance controls.

How does Predictive Modeling improve Claims Management?

Predictive models forecast claim costs, identify high-risk cases early, predict settlement outcomes, and recommend optimal handling strategies to improve efficiency and reduce costs.

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