What it sells
We audit medical claims for self-insured employers and health plans.
Business model breakdown
Buyer: who owns the budget?
TPAs and health plans (payment integrity / claims operations leaders); the site headlines 'Payment integrity for TPAs and health plans'.
Trigger: what makes them buy now?
UnverifiedSelf-funded plan spend lost to billing, coding and contract errors that manual high-dollar-only review misses; podcast pages also cite GLP-1 and specialty drug cost pressure on TPAs.
Workflow: what inputs become what output?
Ingest raw claims in any format (CSV, 837/835), normalize them, audit 100% of claims with ML plus clinician review, parse medical records to verify necessity against codes, then run post-pay recovery through negotiation and dispute with tracked reconciliation; voice AI agents handle provider calls.
Economics: what it saves and how it charges
Contingency model: 'we only charge for actual savings' with zero implementation fees; claims customers save 2-7% of annual plan spend.
Distribution: how it reaches customers
Demo-led ('Book a demo') with podcast content marketing aimed at TPA operators.
Funding history and coverage
| Round date | Stage | Amount | Investors | Source |
|---|---|---|---|---|
| — | Y Combinator Summer 2025 | — | Y Combinator | ycombinator.com |
Profiles summarize public reporting and company websites. Business-model notes are MaxBC's reading of that material, not confirmed facts; unknowns are left blank rather than guessed. Updated 2026-10-12.