Built for US Healthcare Payers
Catch Fraud Before It Hits Your Balance Sheet.
ClaimSentinel flags high-risk claims in real time using behavioral patterning and historical leakage markers, so your team only reviews what actually needs attention.
*No long-term commitment, cancel anytime.*
*Instant savings first, monthly updates on the 1st.*
THE CLAIMSENTINEL ADVANTAGES
Why Choose Us ?
Why Choose Us ?
Why Choose Us ?
ClaimSentinel delivers precision fraud detection purpose-built for claims teams, helping you reduce manual overhead, cut leakage, and protect your book without disrupting your existing systems.
ClaimSentinel delivers precision fraud detection purpose-built for claims teams, helping you reduce manual overhead, cut leakage, and protect your book without disrupting your existing systems.
ClaimSentinel delivers precision fraud detection purpose-built for claims teams, helping you reduce manual overhead, cut leakage, and protect your book without disrupting your existing systems.
Federated AI-Powered Pattern Detection, No Extra Work
ClaimSentinel learns from your historical approvals, denials, and reversals to auto-flag anomalies within your existing workflow, no training needed.
Federated AI-Powered Pattern Detection, No Extra Work
ClaimSentinel learns from your historical approvals, denials, and reversals to auto-flag anomalies within your existing workflow, no training needed.
Federated AI-Powered Pattern Detection, No Extra Work
ClaimSentinel learns from your historical approvals, denials, and reversals to auto-flag anomalies within your existing workflow, no training needed.
Real-Time Fraud Risk Scoring
Each claim gets an instant risk profile, giving your examiners a clear view of what to review, and what’s noise.
Real-Time Fraud Risk Scoring
Each claim gets an instant risk profile, giving your examiners a clear view of what to review, and what’s noise.
Real-Time Fraud Risk Scoring
Each claim gets an instant risk profile, giving your examiners a clear view of what to review, and what’s noise.
Modular Integration – Zero Core Disruption
Plug ClaimSentinel into your current intake or pre-adjudication pipeline. No rip-and-replace. No delays. Just better decisions.
Modular Integration – Zero Core Disruption
Plug ClaimSentinel into your current intake or pre-adjudication pipeline. No rip-and-replace. No delays. Just better decisions.
Modular Integration – Zero Core Disruption
Plug ClaimSentinel into your current intake or pre-adjudication pipeline. No rip-and-replace. No delays. Just better decisions.
Pre-Adjudication Compatible
Behavioral Pattern Analysis
Anomaly Flagging
Faster Triage Workflows
Pre-Adjudication Compatible
Behavioral Pattern Analysis
Anomaly Flagging
Faster Triage Workflows
Pre-Adjudication Compatible
Behavioral Pattern Analysis
Anomaly Flagging
Faster Triage Workflows
Instant Savings
Auto Risk Scoring
Immutable Audit Logs
Machine-Learned Rules
Instant Savings
Auto Risk Scoring
Immutable Audit Logs
Machine-Learned Rules
Instant Savings
Auto Risk Scoring
Immutable Audit Logs
Machine-Learned Rules
BENEFITS
Why We Shine ?
Why We Shine ?
Why We Shine ?
Proactively reduce waste, fraud, and abuse in claims workflows. ClaimSentinel plugs into your adjudication pipeline to surface risk, optimize examiner time, and deliver defensible audit clarity, all without core disruption.
Proactively reduce waste, fraud, and abuse in claims workflows. ClaimSentinel plugs into your adjudication pipeline to surface risk, optimize examiner time, and deliver defensible audit clarity, all without core disruption.
Proactively reduce waste, fraud, and abuse in claims workflows. ClaimSentinel plugs into your adjudication pipeline to surface risk, optimize examiner time, and deliver defensible audit clarity, all without core disruption.
High-Risk Claim Detection
Flag anomalous claims in real-time using machine-learned patterns, no human rules-tuning required.
High-Risk Claim Detection
Flag anomalous claims in real-time using machine-learned patterns, no human rules-tuning required.
High-Risk Claim Detection
Flag anomalous claims in real-time using machine-learned patterns, no human rules-tuning required.
Risk Scoring + Examiner Prioritization
Help your team focus where it matters. Each claim gets a score, with breakdowns of why it was flagged.
Risk Scoring + Examiner Prioritization
Help your team focus where it matters. Each claim gets a score, with breakdowns of why it was flagged.
Risk Scoring + Examiner Prioritization
Help your team focus where it matters. Each claim gets a score, with breakdowns of why it was flagged.
Modular Integration
No rip-and-replace needed. ClaimSentinel drops in at the intake or suspend queue layer.
Modular Integration
No rip-and-replace needed. ClaimSentinel drops in at the intake or suspend queue layer.
Modular Integration
No rip-and-replace needed. ClaimSentinel drops in at the intake or suspend queue layer.
Immutable Audit Logs
Every fraud flag, override, or dismissal is logged, giving SIU teams a clean chain of logic.
Immutable Audit Logs
Every fraud flag, override, or dismissal is logged, giving SIU teams a clean chain of logic.
Immutable Audit Logs
Every fraud flag, override, or dismissal is logged, giving SIU teams a clean chain of logic.
Adaptive Pattern Recognition
The engine evolves as more claims flow through, becoming smarter with your own data over time.
Adaptive Pattern Recognition
The engine evolves as more claims flow through, becoming smarter with your own data over time.
Adaptive Pattern Recognition
The engine evolves as more claims flow through, becoming smarter with your own data over time.
Trusted Ops Support
We work with examiners, not against them. Our success depends on your team actually using the signal.
Trusted Ops Support
We work with examiners, not against them. Our success depends on your team actually using the signal.
Trusted Ops Support
We work with examiners, not against them. Our success depends on your team actually using the signal.
PROCESS
Our Approach
Our Approach
Our Approach
ClaimSentinel is designed for fast onboarding, clear visibility, and zero disruption. Here’s how we deliver value, without complicating your stack.
ClaimSentinel is designed for fast onboarding, clear visibility, and zero disruption. Here’s how we deliver value, without complicating your stack.
ClaimSentinel is designed for fast onboarding, clear visibility, and zero disruption. Here’s how we deliver value, without complicating your stack.
01
Frictionless Integration
Drop-in deployment without touching your core adjudication system
API-first setup, with optional CSV or SFTP compatibility
No engineering lift required from your team
01
Frictionless Integration
Drop-in deployment without touching your core adjudication system
API-first setup, with optional CSV or SFTP compatibility
No engineering lift required from your team
01
Frictionless Integration
Drop-in deployment without touching your core adjudication system
API-first setup, with optional CSV or SFTP compatibility
No engineering lift required from your team
02
AI-Driven Signal, Not Noise
Each claim scored using learned fraud patterns
Risk factors transparently surfaced
No black boxes, just prioritized focus for examiners
02
AI-Driven Signal, Not Noise
Each claim scored using learned fraud patterns
Risk factors transparently surfaced
No black boxes, just prioritized focus for examiners
02
AI-Driven Signal, Not Noise
Each claim scored using learned fraud patterns
Risk factors transparently surfaced
No black boxes, just prioritized focus for examiners
03
Clear, Consistent Communication
Live implementation dashboard and check-ins
Alerts for flagged spikes, anomalies, or override trends
SIU-ready summaries on demand
03
Clear, Consistent Communication
Live implementation dashboard and check-ins
Alerts for flagged spikes, anomalies, or override trends
SIU-ready summaries on demand
03
Clear, Consistent Communication
Live implementation dashboard and check-ins
Alerts for flagged spikes, anomalies, or override trends
SIU-ready summaries on demand
04
Modular & Adaptable
Deploy only what you need (fraud flagging, audit trail, or both)
Scale up or pause at any time
Flat, predictable pricing, no usage creep
04
Modular & Adaptable
Deploy only what you need (fraud flagging, audit trail, or both)
Scale up or pause at any time
Flat, predictable pricing, no usage creep
04
Modular & Adaptable
Deploy only what you need (fraud flagging, audit trail, or both)
Scale up or pause at any time
Flat, predictable pricing, no usage creep
PRICING
Choose the Perfect Plan
We offer flexible pricing plans that align with where your business stands today and where it's headed.
Lets setup a 15 minute call to figure out if we can help you.
Start Saving More and Streamlining Your Business Today.
Experience the power of automated savings and optimized spending. Get started now to boost your business efficiency and maximize returns.
Start Saving More and Streamlining Your Business Today.
Experience the power of automated savings and optimized spending. Get started now to boost your business efficiency and maximize returns.
Start Saving More and Streamlining Your Business Today.
Experience the power of automated savings and optimized spending. Get started now to boost your business efficiency and maximize returns.