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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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.
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Wellworks For You

Wellworks For You

4.1 (40)
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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
Bluespine

Bluespine

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-

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1,200,000

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80% of healthcare claims are paid with billing errors. For the average self-insured employer, they are wasting as much as 10% of their annual healthcare spend on overpayment violations. Bluespine prevents medical overpayments... Show More
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BMI Audit Services

BMI Audit Services

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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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Sterling Wellness Solutions, L.L.C.

Sterling Wellness Solutions, L.L.C.

3.1 (6)
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Founded

2001

Employees

50

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None

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About Sterling Wellness Solutions, L.L.C.

At Sterling Wellness Solutions, we believe that health and well-being are the foundation for a fulfilling life. Our total approach to employee wellbeing provides innovative and personalized solutions that empower individuals and organizations to achieve their health goals. We are committed to a holistic approach that considers the physical, mental, and emotional aspects of health, and we believe that preventive care is key to a healthy lifestyle. Our values of integrity, empathy, collaboration, and accountability guide us as we create a culture of wellness that inspires individuals to take control of their health. With our expertise and support, we strive... 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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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
Budgie Health Inc.

Budgie Health Inc.

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-

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110,000

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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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finHealth

finHealth

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600 eligible

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700,000

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Our AI enabled software solution analyzes in real-time 100% of medical and pharmacy claims, providing timely and actionable insights to prevent erroneous payments, drive cost savings and quality improvements while simultaneously upholding the... Show More
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Innovu

Innovu

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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
Meeko Health

Meeko Health

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Founded

2023

Employees

0

Funding Summary

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
Wellnecity

Wellnecity

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2,500 eligible

Lives Serviced

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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Agility Innovation Partners

Agility Innovation Partners

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Founded

Employees

0

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Not Provided

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Broadspire Services, Inc.

Broadspire Services, Inc.

5.0 (1)
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Founded

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0

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Dart Health

Dart Health

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Founded

06/2022

Employees

0

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Not Provided

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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
Mede Analytics

Mede Analytics

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Founded

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0

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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
MyChoice Accounts by Businessolver

MyChoice Accounts by Businessolver

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-

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-

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Businessolver partners with MultiPlan to offer additional analytics and optimization capabilities for our clients. MultiPlan's system takes employers’ existing healthcare data and combines it with predictive modeling to provide specific medical plan recommendations... Show More
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WellRithms

WellRithms

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Founded

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0

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PlanSource Benefits Administration, Inc.

PlanSource Benefits Administration, Inc.

3.2 (11)
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Founded

2008

Employees

650

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About PlanSource Benefits Administration, Inc.

Founded in 2008, PlanSource is a benefits administration company on a mission to make it easier for people to choose, use, and manage benefits through engaging, AI-powered experiences. PlanSource solves even the most complex benefits challenges for thousands of customers by pairing a comprehensive suite of strategic administration services with a modern and highly configurable platform. Leading the market in meaningful integration of AI, PlanSource has an unmatched range of ecosystem connections that drive continual innovation and value to clients, partners, and consumers. Headquartered in Orlando, Florida, PlanSource supports more than 5 million consumers through partnerships with more than 3,400 employers... 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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