Platform

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
Rules

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

workflow
Workflow

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

analytics
Analytics

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

integrations
Integrations

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

machine-learning
Machine Learning

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

automate
Automate

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

data-interface
API and Data Interfaces

Securely exchange relevant Payment Integrity data with ClaimShark API Gateway

security
Security

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
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-builds
Rapid Build

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