For your organization
Insurer / TPA
Insurers and TPAs need pre-auth, claims, and member journeys aligned with provider data — without duplicating PHI.
Typical pain points we address
- Authorizations bounce between portals and email threads.
- Fraud and duplicate claims require cross-system correlation.
- Member communications are inconsistent across channels.
Modules most often activated first
- Pre-auth workflows
- Claims intake
- Member services
- Analytics & risk flags
Workflow narrative
- Ingest provider requests with structured clinical context.
- Route decisions with SLA timers and appeals.
- Settle claims with reconciliation to finance systems.
“We reduced turnaround variance by giving reviewers the same clinical context providers see.” — Head of operations, Regional TPA