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Health Plans

Bringing enterprise financial control into focus through integrated cost optimization and intelligence solutions.

Precision and clarity matter at every stage of the plan lifecycle.

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.

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Featured Solutions

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.

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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.

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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.

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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.

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  • 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

  • They (Claritev) are continuously refining and developing the platform to meet my needs.

    A Major Healthcare Provider

  • The Technology Leadership Program has brought my department tremendous value. The well-structured program offers the talented hardworking associates options for their career paths, yet exposes them to high visibility initiatives. Every associate has brought a unique perspective and strong professional skills to the organization.

    Bobby Vincent

    Senior Information Technology Director

  • The Technology Leadership Program associates have a tremendous opportunity before them. To have three years to rotate through various departments within Information Technology before deciding which role/area suits them best.  Depending on their choice and interest, they become a unique blend of technologist, business expert and, eventually, corporate leader.

    Andrew George

    Senior Vice President, Information Technology

  • One of the great successes of the program has been our ability to identify and develop emerging leaders whom contribute in every facet of our business. It hasn’t been just about growing IT leaders, it’s about maturing business leaders for Claritev.

    Ed Ververs

    Senior Director, Telecom & Data Center Management

  • I had the privilege to mentor some of the Technology Leadership Program participants and was fortunate to absorb a member into my team, where he has helped tremendously with new automation techniques. Participants bring in fresh perspectives and extreme enthusiasm to IT here at Claritev. I’m looking forward to adding more.

    Vasu Raghunathan

    Senior Director of Data & Service Delivery

  • You have been a great partner from day one. You collaborate with us until we find a resolution. We look forward to a long-standing partnership.

    Payment Integrity and Performance Manager

  • The things we value most about our partnership with Claritev are not just the reliable, efficient delivery of savings through their MSP and ESRD services, but the fact that they are always willing to come to the table to discuss and collaborate on new and innovative solutions that nobody else in the industry has yet to try.

    Drew Satriano, VP of Payment Integrity

    Highmark, Inc.

  • In our experience, Claritev has been very responsive with great turnaround times and the findings they’ve presented to SIHO have been accurate and reasonable.

    Claims Department

    SIHO Insurance Services, Inc.

Engaging insights.

Claritev insights, resources, and case

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Ready to move from fragmented cost containment efforts to integrated financial control?

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.

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