Healthcare Solutions


ClaimShark is a secure cloud-based solution that breaks down silos, aligns activities and brings oversight to the entire Payment Integrity effort. It empowers the Health Plan Payment Integrity stakeholders by giving them real time information and visibility to the life cycle of a claim from the time it is touched by a vendor all the way to collections and recovery.



is built on a hub and spoke model with the hub being the Health Plan and the spokes being the internal audit team and the different vendors that are contracted to recover over payments. Internal teams and vendors can be engaged based on criteria like lag, plan type, geographic allocation, dollar value, recovery type (concepts) and claim

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With robust dynamic dashboards that can be customized, Health Plans and vendors get a detailed real time update on the life cycle of the claim, type of recovery by volume and value, plan vs. actual, vendor, provider and more

Dynamic workflow:

Health Plan and vendor can setup their individual workflow queues to manage internal routing and reporting


Vendors get detailed visibility to the productivity of their auditors and collection agents. Vendor details are rolled up, so Health Plans get a comprehensive view of recoveries by vendors, return on investment and value generated.

Financial Oversight:
With every claim tracked from identification to recovery, the Health Plan can track and predict recoveries by month, quarter and year. With details on the claims by different statuses, recoveries can be accelerated to meet any quarterly financial shortfalls

Provider Abrasion: Payment Integrity efforts have a direct impact on NPS and Provider grievances. With a consolidated data by claim and provider, the Health Plan can get reports on which providers are contacted multiple times and preempt any complaints or grievances. The Payment Integrity efforts can be turned up or down to minimize Provider noise.

Analytics: With a robust Datawarehouse and detailed activity log, advanced analytics can help bring transparency and visibility to the Payment Integrity efforts.