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Healthcare Segment: Payers

  • Pink and blue background with wooden building blocks set upon background in a stepped up formation, hand adding final block

    Building Blocks to Help Healthcare Payors Thrive in Our New Normal

    Healthcare payors are navigating uncertainty in the “new normal,” facing challenges like shifting claim volumes, cost pressures, and limited resources. By leveraging flexible, customizable building blocks—such as network-based, analytics-driven, and payment integrity solutions—organizations can adapt to change, maintain financial control, and strike a balance between cost savings, provider relationships, and member satisfaction. [claritev.com]

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    Seven Network-Based Functions You Should Take Off Your Plate

    Managing a Medicare Advantage network involves complex, resource-intensive tasks—from ensuring adequacy and compliance to credentialing, provider support, and reporting. By offloading these seven network-based functions to a trusted partner, healthcare payors can streamline operations, maintain regulatory alignment, and focus on strategic priorities while improving network performance and efficiency.

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  • Business man touching a screen with the words "machine learning" displayed

    Machine Learning Drives Efficiencies at Claritev

    Machine learning is helping drive efficiency and accuracy across healthcare operations by enabling systems to learn from data and automate complex processes. At Claritev, this technology is used to prioritize claim reviews and enhance payment integrity, allowing teams to focus on high-value tasks, reduce manual effort, and scale operations while delivering greater value to clients.

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  • Male patient leaning on counter in waiting area as he chats with male doctor and female receptionist on the other side

    Strong Networks Begin with Strong Healthcare Provider Relationships

    Strong provider relationships are the foundation of effective healthcare networks. By leveraging long-standing partnerships, deep provider insights, and an extensive network, healthcare payors can build compliant, high-performing networks faster—improving access to care while maintaining efficiency, flexibility, and strong collaboration across the healthcare ecosystem.

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    Case Study: Strategic negotiations

    A large healthcare carrier faced the challenge of enhancing protection against balance billing while preserving the cost advantages of its reimbursement model. Through strategic negotiation parameters—balancing provider incentives and member value—Claritev delivered more transparent agreements, achieving significantly higher savings with minimal impact on negotiation success rates.

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    Case Study: Retaining important business

    Claritev analysis helped a third-party administrator defend against a competitor’s push to implement Medicare pricing by: significantly improving savings for the employer and its members; engaging important providers in the new process; and preserving the community’s provider-patient relationships.

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  • Two males and two females at conference table with laptop and coffee

    Case Study: Navigating a challenging environment

    An auto medical services provider wanted to distinguish its network-based cost management program to sensitive auto insurance carriers by demonstrating: minimal provider noise through the use of network contracts to reduce medical cost; effective dispute resolution processing.

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    Case Study: Meeting a specific need quickly

    A health plan facing tight deadlines needed rapid access to providers to meet network adequacy requirements. By leveraging existing contracted providers and targeted credentialing strategies, Claritev enabled faster network expansion—helping the plan meet compliance requirements, accelerate market entry, and maintain flexibility for future growth.

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