Built for the people who answer for turnaround.
A claims operations leader is accountable for decisions made across vendors they do not control, on timelines they cannot see. This is what changes.
The operating case
Four things a claims operations leader can judge for themselves, without a projection.
Where time is actually lost
Rarely in the decision itself. It goes at intake, when the same request arrives three ways; in missing records, when a file waits on one report; in handoffs, when the reviewer receives an incomplete packet; and in service, when a decision is made but not yet communicated.
What consolidation changes
When clinical decisions and payment decisions run on one workflow, across utilization review, pharmacy, bill review, peer review and case management, a request is not re-keyed between vendors. One record follows it from intake to service, and there is one place to look when something stalls.
What visibility changes
A leader who can see every open request with its remaining time can move work before it expires instead of explaining it afterwards. Risk becomes a sort order, not a surprise in a monthly report.
What an auditable record is worth
When a decision is challenged, the question is what was known, by whom, and when. A record that captures inputs, reviewer, communication, timing and outcome as one chain answers that without a reconstruction exercise.
What your team does differently in week one
- 1Administrators start the day from one queue sorted by time remaining, not from an inbox.
- 2Incoming faxes, emails and portal uploads attach to the claim they belong to, with the arrival time recorded.
- 3Requests to provider offices name the exact document needed, and the follow-up is tracked on the claim.
- 4Files go to clinical reviewers assembled, with evidence in date order and the relevant guideline cited.
- 5Bills reach billing and coding specialists with the matching authorization attached, so unauthorized lines are flagged before payment.
- 6Supervisors check open requests by owner and remaining time instead of asking for status by email.
Working alongside what you already run
Claimatix connects to the systems your team already uses rather than replacing them. Your claims system stays the system of record; Claimatix runs the decision workflow around it and writes the outcome back.
- Claims administration systems
- Document management
- Provider portals
- Fax lines
A pilot, scoped so it can fail cheaply
One decision pathway, one queue, metrics agreed up front and a defined end date.
Step 1
Choose one pathway
Pick a single decision type and a single queue where turnaround matters to you.
Step 2
Agree the measures
Decide together, before anything starts, what success and failure look like.
Step 3
Run it alongside your team
Your administrators and reviewers work the queue for a period agreed with you.
Step 4
Review and decide
On the end date, compare against the agreed measures and decide whether to continue, change or stop.
See the state of the work, not just the volume.
A compact view of where open requests sit today. It is a working view for supervisors, not a performance claim.
Request a private briefingStatus at a glance
Today
Awaiting records
14
With reviewer
9
Decision ready
6
Served today
11