ClaimShark, our Payment Integrity Platform is purpose built to help Health Plans solve their Payment Integrity challenges with pre-built capabilities embedded into our offerings. By building scalability, data availability, security and collaboration across our offerings, the ClaimShark platform will help improve operational efficiency, decision-making and Payment Integrity savings.

Pre-built tools and functionality within our ClaimShark platform include:


Rules empower your team to write, change and test without the need to code resulting in smarter decisions.


Leverage the inbuilt functionality with our platform to design and model your Payment Integrity and Audit processes


Store, Process, Analyze and Visualize your Health Plan claim, member, provider and Payment Integrity data for better insights and decision making


Leverage our pre-built integrations to Vendors, Claim Systems, Provider Portals and other software vendors

Machine Learning

Deliver higher savings and impact productivity leveraging pre-built Payment Integrity ML & AI models


Bridge systems leveraging BOTS to move data between systems and automate processes like data collection impacting COB, and offsets

API and Data Interfaces

Securely exchange relevant Payment Integrity data with ClaimShark API Gateway


HiTrust certified data centers and SOC 2 certified data and monitoring tools protect your data across our platform both at rest and during transit

Scale Fast

Ability to increase or decrease resources as needed to meet changing business demand, ClaimShark platform can offer both flexible and scalable solutions

Rapid Build

Deploy changes and functionality to meet business needs leveraging the platform tools