Amera provides an infrastructure‑grade platform that ingests any claim format—EDI, PDFs, paper bills, faxes, or proprietary data—and converts it into a standardized, structured format. The solution automates the entire claims workflow, from intake and validation through carrier submission and real‑time analytics, using AI‑driven routing, configurable business rules, and built‑in compliance checks to achieve high auto‑adjudication rates while maintaining accuracy.
Funding
Funding not disclosed
Founders
Product
Problem
Health plan and TPA operations rely on legacy, disconnected systems that require manual processing of diverse claim formats, leading to high error rates and costly rework. The fragmentation prevents rapid adoption of modern benefit designs and delays stop‑loss reporting.
Solution
Amera offers an infrastructure‑grade platform that ingests any claim document—EDI files, PDFs, paper bills, faxes, or proprietary data—and converts it into a standardized, structured format. The platform automates the entire claims workflow, from intake and validation through carrier submission and real‑time analytics, using AI‑driven routing and configurable business rules. Built‑in compliance checks, duplicate detection, and eligibility verification enable high auto‑adjudication rates while maintaining accuracy. The unified system serves as a data layer that connects existing legacy applications without requiring their replacement, delivering immediate ROI and faster stop‑loss recoveries.
Target Audience
Primary customers are third‑party administrators (TPAs) and self‑funded health plans that manage large volumes of claims and need to modernize their operations.
Features
- Unconventional Claims Clearinghouse that normalizes any claim format into a single intake pipeline with 99%+ data accuracy
- AI‑powered pre‑processing engine that learns business rules to achieve 85%+ auto‑adjudication and smart duplicate detection
- Real‑time eligibility and provider verification integrated into the workflow
- Configurable compliance and error‑flagging checks to ensure regulatory adherence
- Scalable architecture capable of processing millions of claims and serving as the system‑of‑record for health plan operations
- Real‑time visibility and analytics dashboard for monitoring claim status, carrier disputes, and stop‑loss thresholds