Built for a client whose audit process relied on manual sampling across disconnected spreadsheets, this solution stratifies and pulls randomized claims samples based on configurable variables and thresholds — making them immediately available for live, collaborative review across multiple teams. The result is a repeatable, defensible process that surfaces risk before it becomes a finding.

Centralizes client administration across pricing, billing, enrollment counts, transition credits, and Pharmacy rebate tracking for self-insured clients — giving Sales, Customer Success, and Leadership a single source of truth for SLA performance, financial obligations, and population-level metrics.

Manages referral intake, routing, authorization linkage, and status tracking across Utilization Management, Enhanced Care Management, Behavioral Health, and Dental. Closes referral gaps, reduces manual handoffs between care teams and providers, and surfaces overdue referrals before they become compliance issues.

Built for a client tracking vendor and provider contracts across a tangle of spreadsheets and shared drives, this solution centralizes contract records with automated review cycles, expiration alerts, and renewal workflows. It surfaces contract risk before it becomes a compliance or budget problem — with a structured, audit-ready record that reflects the organization's current regulatory posture.

Generates member and provider correspondence directly from live system data — NOAs, denial letters, EOBs, and regulatory notices. Supports multi-language output, preferred format delivery, and version-controlled templates to maintain compliance across regulatory changes.

Tracks enrollment status changes, eligibility gaps, and regulatory correspondence in real time. Supports DHCS and CMS continuity-of-coverage requirements, auto-generates required notices, and flags members at risk of losing coverage before disenrollment occurs.

Designed for a client whose policy governance lived in static document libraries with no ownership or review accountability, this solution stores organizational policies as structured, versioned records with ownership assignments, review schedules, and change history. The result is a searchable, audit-ready governance system that reflects the organization's current regulatory posture at any point in time.

Gives providers a single interface to submit claims, request authorizations, verify member eligibility, and track status — without calling into Utilization Management or Claims. Provider-submitted data is automatically processed and routed to the correct internal Healthcare Payer Organization teams, triggering targeted workflows so each department receives exactly what they need to act. Reduces provider friction, cuts inbound call volume, and shortens authorization turnaround for routine requests.

Supports end-to-end underwriting operations — from evaluating member risk profiles and structuring coverage terms to setting premiums and monitoring portfolio-wide loss trends. Consolidates claims history, compliance data, and financial exposures into a single workspace so underwriters can price accurately, manage concentration risk, and coordinate loss prevention across the membership pool.