Claims Intelligence
Know where every healthcare dollar goes.
Analyze total cost of care by member, provider, and medical center. Track monthly trends, surface high-cost members, and catch anomalies and duplicate claims.
The challenge
Why Claims & Financial Intelligence
- Spend data arrives late and in inconsistent formats.
- High-cost members are identified after the cost is incurred.
- Duplicate and anomalous claims slip through.
Guardrail: Claims-only analysis is labeled as such: claims lack clinical detail and arrive with lag.
$630.2K 12-month total cost · $1.1K PMPM
Capabilities
What's included
Total cost of care
Medical and pharmacy breakdowns where source data supports them.
Member & provider spending
Rank and drill down by member, provider, or medical center.
Monthly cost trends
Trend lines with filters for organization and provider.
Anomaly & duplicate detection
Flags suspicious patterns for analyst review.
Billing Pay To & FundCode
Group spend by Pay-To entity and fund code.
Claims data quality monitoring
Completeness and validity checks on every load.
Workflow
How it works
- 01
Ingest claims CSV / feed
- 02
Validate & dedupe
- 03
Attribute to member & provider
- 04
Aggregate cost views
- 05
Flag anomalies
Experience TheFlashAI
Explore the interactive demo with synthetic data, or talk to our team about your organization.