Health Plans

Health plans operate in a market defined by rising medical costs, increasing transparency mandates, evolving CMS oversight, and mounting pressure to differentiate. Payment errors erode margins. Network gaps weaken competitiveness. Fragmented data slows decision-making.

Claritev helps bring these moving parts into alignment with a comprehensive portfolio of solutions that aim to empower health plans to move beyond siloed cost-containment efforts and toward enterprise alignment with greater financial control.

Together, these solutions can help:
• Improve predictability of medical spend and reimbursement exposure
• Optimize network performance and reimbursement alignment
• Validate and benchmark pricing strategy with reliable marketing intelligence
• Reduce volatility from out-of-network exposure
• Translate complex data into confident financial decisions

When every dollar and every provider relationship counts, clarity becomes one of the most important operational advantages.

End-to-end innovations designed to support health plan performance.

Payment and Revenue
Integrity Solutions

Increased waste and inaccurate payments continue to drive up health expenditures. We aim to bring clarity to the process by driving accuracy before, during, and after a claim, helping to reduce waste and abuse across the healthcare ecosystem.

Network Solutions

Network strategy is foundational for sustainable financial performance. We help health plans
gain greater flexibility and control over reimbursement and access, enabling more confident medical spend management and cost control.

Claims Intelligence Solutions

Escalating costs and surprise bills put pressure on both plans and members. Our Claims Intelligence Solutions aim to clarify the complexity with expert negotiation, reference-based pricing solutions, and surprise billing solutions that help support fair reimbursement for healthcare services and preserve member access and experience.

Data and Analytics Solutions

Health plans need clarity and confidence in
their data. When pricing and cost dynamics are clear, health plans can act decisively, govern their operations more strategically, and manage trends with greater predictability to drive smarter strategies and long-term performance.

Q&A Kinetiq Health’s Chief Clinical Officer

Sarah Michaels, Chief Clinical Officer of Kinetiq Health, makes the opportunity clear: healthcare can use data to make decisions that lead to better outcomes for everyone.

  • In a remote community like ours, we do not have local access to every type of medical specialist. The MAVEN Project gives our providers a trusted resource when a patient’s care would benefit from specialist input and helps us make better-informed decisions about whether someone truly needs to travel off island. This grant means we can continue that support for another year.

    Chief Executive Officer, Kodiak Community Health Center

    Olivera Wilson

  • When someone comes through our doors with a serious or uncertain condition, every minute matters. Having portable ultrasound available at the bedside will give our clinicians another important tool to understand what is happening and make decisions faster. We are incredibly grateful to Claritev Cares and to our community for helping us get this across the finish line.

    Chief Executive Officer, Fairfield Memorial Hospital

    Andy Flemer

  • Rural healthcare organizations know exactly what would make a difference for their patients. The challenge is often finding the resources to make it happen. These grants help close that gap. One will put important diagnostic technology directly at the bedside, and the other will help patients benefit from specialist expertise without automatically having to leave their island community.

    Executive Director, Claritev Cares

    Andrew Loudner

  • Accurate payments help reduce unnecessary administrative costs, support stronger payer-provider relationships, and contribute to a healthcare system that promotes affordability and predictability for the people who depend on it every day.

    Chief Operating Officer, Claritev

    Jerry Hogge

  • Claritev’s broad pre-pay value chain coverage and clinical negotiation experience give it a foundation to support payers on upstream payment accuracy needs.

    Vice President, Everest Group

    Ankur Verma

  • The grant money we received from Claritev was used to support additional resources that allow our respiratory therapists to spend more time empowering and educating patients.

    Lisa Emery

    Director, New River Health Association Breathing Center

  • These resources were created to help military and veteran caregivers more easily understand options for meaningful mental health care for themselves and their families. Caregivers shoulder extraordinary responsibilities every day, and they deserve clear, trusted guidance that helps them navigate complex healthcare systems with greater confidence.

    Steve Schwab

    Chief Executive Officer, Elizabeth Dole Foundation

  • This collaboration (with the Elizabeth Dole Foundation) reflects a shared commitment to helping military and veteran caregivers navigate mental healthcare more clearly and confidently. These families have given so much in service to our country, and they deserve resources that are practical, accessible, and grounded in empathy.

    Carol Nutter

    Board Chair of Claritev Cares & Chief People Officer, Claritev

  • Your team is great at building trust. I have had nothing but a positive and efficient experience.

    Manager

    Large Midwest health plan

  • These are really important things that we wouldn’t be able to do without a partner like Claritev because, again, we want to look at this stuff holistically across carriers. It would take me four times as long to go into every health plan and do this kind of analysis.

    Executive Vice President

    Large, regional consulting firm/insurance brokerage

Engaging insights.

Claritev insights, resources, and case

  • Strategic Guide: The Operational Value of Healthcare Pricing Intelligence

    Healthcare transparency data offers significant potential, but turning it into actionable insights requires the right strategy. Learn how healthcare pricing intelligence helps organizations improve…

    Read More
  • Rethinking Payment Integrity: Why Prevention Is a Strategic Advantage

    Stopping overpayments before they occur can generate significantly greater value than recovering them after the fact. Explore the advantages of pre-pay payment integrity programs…

    Read More
  • The Connection Between Better Decision-Making and Healthcare Affordability

    Healthcare affordability and access are often viewed as competing priorities—but they don’t have to be. By leveraging data-driven insights, network strategy, and greater price…

    Read More
Pattern

Connect with Claritev to explore how our solutions can help strengthen network performance, validate pricing strategy, and govern their operations and financial outcomes with confidence.