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"We help small and mid-sized TPAs reduce manual claims processing effort without replacing their existing claims platform."

Delivery Model

 

Step 1: Assess

Through our Claims Operations Assessment & Automation Roadmap, we identify operational bottlenecks, quantify manual effort, and prioritize opportunities for improvement.

Step 2: Prioritize

We evaluate opportunities based on business impact, implementation effort, and organizational priorities to create a practical improvement roadmap.

Step 3: Optimize

We implement targeted improvements designed to reduce manual effort, improve operational efficiency, and extend the value of existing claims platforms.

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1. Claims Operations Assessment & Automation Roadmap

Best for: TPAs and benefits administrators experiencing excessive manual claims processing, recurring exception handling, EDI issues, or operational bottlenecks and looking for a practical path to improvement.

What we deliver:

  • Current-state assessment of claims operations, EDI workflows, exception handling, and downstream financial processes

  • Identification and quantification of high-effort manual activities

  • Review of claims, finance, and operational workflows across people, process, and technology

  • Technical feasibility assessment for automation opportunities

  • Prioritized list of automation candidates with estimated effort and business impact

  • Implementation roadmap including recommended business and technical solutions

Typical duration: 2 weeks

Business outcomes:

  • Clear understanding of operational inefficiencies

  • Prioritized automation opportunities

  • Executive-ready business case and implementation roadmap

  • Foundation for targeted automation initiatives

3. Claims Workflow Automation & Exception Processing

Best for: Organizations whose claims teams spend significant time manually re-keying claims, managing exceptions, rerouting transactions, or compensating for system limitations.

What we deliver:

  • Business and technical analysis of exception workflows

  • Process redesign and automation architecture

  • Requirements definition and implementation backlog

  • Development of targeted workflow automation solutions

  • Claims routing, enrichment, and exception handling enhancements

  • Testing support, deployment coordination, and user adoption planning

Typical duration: Varies by scope

Business outcomes:

  • Reduced manual claims processing effort

  • Faster claims turnaround times

  • Improved operational consistency

  • Reduced staffing pressure as claim volumes grow

2. Paper Claims & Claims Intake Automation

Best for: Organizations managing paper claims, manually entered claims, VIP workflows, provider-submitted forms, or other non-standard claim intake processes that require significant manual effort to enter and process.

What we deliver:

  • Assessment of current claims intake and claim creation workflows

  • Analysis of manual entry, re-keying, and validation activities

  • Design of streamlined intake and claims creation processes

  • Development of automated intake and claim creation solutions

  • Implementation of data validation, enrichment, and routing capabilities

  • Integration with existing claims systems and operational workflows

  • Testing support, deployment coordination, and user adoption planning

Typical duration: 4–8 weeks

Business outcomes:

  • Reduced manual claim entry and re-keying effort

  • Improved claim intake accuracy and consistency

  • Faster claim creation and adjudication timelines

  • Reduced processing errors and downstream rework

  • Improved member, provider, and client experience

  • Ability to handle growing claim volumes without additional staffing

4. Claims & EDI Processing Optimization

Best for: Organizations experiencing recurring issues with 837s, 835s, remittance processing, coordination of benefits, denial handling, or other EDI-driven claims workflows.

What we deliver:

  • Assessment of inbound and outbound claims processing workflows

  • Analysis of recurring EDI exceptions and operational impacts

  • Design and implementation of pre-processing and post-processing solutions

  • Claims validation, enrichment, and routing logic enhancements

  • Exception handling and error reduction capabilities

  • Implementation support, testing, and production rollout

Typical duration: Varies by scope

Business outcomes:

  • Reduced EDI processing exceptions

  • Improved remittance accuracy

  • Reduced manual intervention by claims staff

  • Improved operational scalability and reliability

5. Claims Finance & Billing Automation

Best for: Organizations relying on manual Accounts Receivable (AR), Accounts Payable (AP), premium billing, carrier report processing, QuickBooks entry, or other disconnected claims-to-finance workflows.

What we deliver:

  • Assessment of claims-related billing and finance workflows

  • Analysis of manual data entry, reconciliation, and reporting activities

  • Identification of opportunities to streamline claims-to-finance processing

  • Design and implementation of automated import, export, and billing workflows

  • Development of structured data feeds between claims, billing, and financial systems

  • Implementation of validation and exception handling capabilities

  • Testing support, deployment coordination, and operational transition planning

Typical duration: 4–10 weeks

Business outcomes:

  • Reduced manual AR and AP processing effort

  • Improved billing accuracy and financial data consistency

  • Faster invoice, payment, and reconciliation processing

  • Reduced operational dependency on spreadsheets and manual workarounds

  • Improved scalability as client, vendor, and transaction volumes increase

  • Greater visibility into claims-related financial operations

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