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Healthcare Payor's Claim Process Transformation

Claim Sense uncover innovative ways in process claims effectively and efficiently while keeping the cost optimized

Industry Pain Points

Healthcare payers are facing two major challenges in the current healthcare landscape. They need to ensure operational efficiency and lower the claims processing cost in a rapidly changing industry. About 20-30% of claims require manual handling, leading to "pending" statuses and additional fees. Furthermore, processing low-value claims is often more expensive than their actual value, which makes it difficult to decide whether to automate, auto-adjudicate, or handle them manually.

Per Claim Processing Cost
Average Claim Processing Time
30 Days
First-pass Claim Acceptance Rate
Average Claim Backlog
Claims Auto-adjudication Rate
Claim Denial Rate

Our Solution

Claim Sense revolutionizes Healthcare Payors' Claims Operations, enabling swift resolution of pending codes through deep insights into their dependencies. This approach cuts claim iterations by half and significantly reduces the overall claim cycle time, leading to substantial cost savings. Result? A notable 12% decrease in operational expenses, a 40% faster throughput, and a double ROI within three years. Moreover, Claim Sense achieves a 40% auto-approval rate for low-value claims, elevating claim operations to unprecedented levels of efficiency and effectiveness

Uncover Pend Dependency
Utilizing Process Mining technology, our solution sifts through historical claim data, pend codes, and resolution steps to identify specific pend codes and resolution steps tailored to each claim type and characteristic. This analysis provides Claims Operations with actionable insights and instructions, aiming to expedite claim adjudication
Low Value Claim Handling
Optimizes the cost of processing low-value claims by providing insights to decision-making on whether to auto-adjudicate or automate to reducing reliance on manual processes, and ensuring a more efficient claims management system. Through this innovative approach, Payor’s can achieve significant operational cost savings and enhance their auto-adjudication rates, ultimately leading to a more efficient and responsive claims processing environment​​.



Cost Saved
Reduce Turnaround Time
Increase Auto-Adjudication Rate
Increased First-Pass Rate
Automatation Saved
18 FTE

Why Choose Us

50+ Years of Technology Expertise

Our wealth of experience has equipped us with the proficiency to deliver exceptional services to you.

4K+ Processes Modeled

We have effectively assisted organizations with capable process modeling to enhance productivity.

50+ Certified Consultants

Our team, with extensive knowledge, provides the best service and support to meet your needs.

1000+ Tasks Automated

We have successfully automated processes with enormous results benefiting the organization.

Strategic Services for Your Success

Discover our array of expert services crafted to boost your business. From tailored consultations to efficient technology management, we're committed to driving your growth and ensuring success in the digital realm.

Finance Audit & Compliance

Enhance compliance, financial control, and risk management for various industries. It ensures SOP adherence, flags transactional deviations, detects unauthorized approvals and duplicate invoices, and optimizes invoice processing for better cash flow.

Incident Management

Harness data-driven actionable insight to streamline incident management, minimizing rework, reassigns, and SLA breaches, improving service quality and customer experience, and reducing costs ensuring customer satisfaction and loyalty.

Compliance Remediation

Boost SLA compliance and reduce material rejections by optimizing Master Data Management processes in the supply chain domain, optimizing process and data, and ensuring seamless workflow to improve overall performance and productivity.

Here’s how to get started

Effortlessly unlock business success by connecting with a dedicated Advisor, receiving a personalized Technology Roadmap, and focusing on business growth with your technology needs in capable hands.

Schedule a Call

Talk with a dedicated Advisor who can help you assess your company so that you can know exactly what your needs are.

Get a Free Roadmap

After your call, we will send you a personalized Technology Roadmap to help you discover the solutions that are right for you.

Grow Your Business

Now that your technology needs are being handled, you can focus on running your business and staying ahead of the competition.

Let's started today

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