ClaimInformatics

ClaimInformatics is an independent payment integrity and fiduciary compliance firm serving self-funded and captive health plans, TPAs, and benefits brokers. The company's proprietary FOCUS framework and ClaimIntelligence platform apply 850+ proprietary rules to identify improper payments, billing errors, upcoding, and fraud that standard auto-adjudication systems miss, delivering average findings of $500–$1,200 per employee per year. ClaimInformatics operates as a fully independent partner with no revenue relationships from TPAs, networks, or PBMs, ensuring fiduciary alignment under ERISA and the Consolidated Appropriations Act. Its SOC 2-certified, HIPAA-compliant platform provides monthly claims monitoring, recovery services, and compliance documentation for plan fiduciaries.