Claritev offers a technology platform that ingests and analyzes medical charge data to identify overpayments, automate claim processing, and prevent balance‑billing. Its analytics and decision tools help health insurers and employer‑sponsored plans negotiate fair reimbursement rates, manage provider networks, and comply with surprise‑billing regulations, delivering cost transparency and savings.
Funding
$4.5B raised to dateRaised to date based on public sources. This may differ from the amount the company actually raised and is based only on what is publicly available on the internet.
Founders
Product
Problem
Healthcare payers, providers, and members often face opaque medical charge structures, leading to unexpected balance‑billing, overpayments, and difficulty identifying cost‑saving opportunities.
Solution
Claritev provides a suite of technology platforms that ingest and analyze medical charge data to surface fair reimbursement rates and potential savings. The solutions automate claim processing to reduce manual errors and eliminate balance‑billing for plan members. Integrated decision tools deliver actionable insights for plan design, while customizable provider network management enables payers to negotiate and maintain cost‑effective provider relationships. Compliance modules help organizations meet surprise‑billing regulations and ensure transparent, accurate payments across the care continuum.
Target Audience
Primary customers are health insurance payers, provider groups, and employer‑sponsored health plans seeking to improve cost transparency, reduce claim expenses, and enhance member experience.
Features
- Advanced analytics engine that parses medical charges to identify overpayments and negotiate out‑of‑network reimbursements
- Automated claim processing workflow that detects and corrects improper billing, preventing balance‑bills
- Data‑driven decision dashboards for plan design, cost forecasting, and savings identification
- Scalable provider network management tools for building, negotiating, and maintaining custom provider contracts
- Compliance suite supporting NSA surprise‑billing regulations and automated reporting
- Integrated payment processing platform that streamlines electronic provider payments while reducing transaction costs