The Definitive Platform for Healthcare Claims Arbitration
ClaimResolveTM is a software-as-a-service (SaaS) platform providing online access to computer software tools for managing healthcare claims processing, insurance claim denials, medical billing disputes, and healthcare appeals management.
Annual Market Size
Healthcare payment disputes
Appeal Overturn Rate
Denials reversed when appealed
Current Resolution Time
We reduce to under 14 days
Mover Advantage
No direct SaaS competitors
The Market Opportunity
Healthcare claims disputes cost the industry billions annually. The current process is broken - and we have the solution.
Annual Healthcare Disputes
Average Resolution Time
Denial Appeal Rate
Admin Cost Per Dispute
Our Solution
A neutral platform that brings payers, providers, and physicians together to resolve disputes efficiently and fairly.
Automated clinical documentation review against InterQual, MCG, and payer medical policies
Board-certified physicians across 40+ specialties providing independent peer reviews
Legally enforceable dispute resolution that eliminates costly litigation
Immutable audit trail with timestamped evidence sharing between all parties
Secure virtual spaces for real-time case presentation and deliberation
Enterprise-grade security with SOC 2 Type II certification
See the Platform in Action
Powerful dashboards and AI-driven insights for every stakeholder.
Win More Appeals with Smarter Strategies
Track $3.89M in recovered revenue, monitor 70%+ success rates, and manage 156 pending appeals all from one dashboard. AI-powered insights show you exactly which denials to prioritize.
- Denial breakdown by reason with win rate analysis
- Real-time recovery and success rate tracking
- Quick actions for immediate appeal submission
Resolve Claims Faster with Global Settlements
Group similar claims for efficient resolution. Manage 247 claims across 8 active batches with $1.2M in potential recovery. Track proposals, negotiations, and settlements in real-time.
- Intelligent claim grouping by DRG and denial reason
- Real-time negotiation status tracking
- Settlement proposal management
Deep Clinical Analysis in Seconds
Our three-step AI engine extracts evidence from clinical notes, maps against payer policies, and detects conflicts automatically. Get match scores up to 92% with actionable recommendations.
- NLP-powered evidence extraction from clinical notes
- Automated policy mapping and conflict detection
- Historical analysis with match scoring
Expert Review Made Simple
Board-certified physicians review cases with complete clinical context. Track earnings, manage your case queue, and deliver expert opinions with full documentation access.
- Comprehensive case queue with priority indicators
- Earnings tracking and performance metrics
- Secure communications with payers and providers
Built for All Stakeholders
A three-sided marketplace serving payers, providers, and physician advisors.
- Faster recovery of legitimate overpayments
- Reduced provider abrasion
- Compliant audit defense
- AI-powered claim analysis
- Defend against unfair denials
- Reduce write-offs and clawbacks
- Neutral physician review process
- Faster cash flow resolution
- Flexible case review scheduling
- Specialty-matched assignments
- Competitive compensation
- Clinical expertise monetization
Why Now?
Rising Audit Activity
Post-COVID recovery efforts have intensified payer audits, creating unprecedented demand for resolution services.
AI Maturity
Large language models can now accurately interpret clinical documentation and medical necessity criteria.
Digital Transformation
Healthcare is finally embracing digital workflows, making a platform solution viable at scale.
Regulatory Tailwinds
CMS and state regulations increasingly favor binding arbitration over litigation for healthcare disputes.
Why ClaimResolve Wins
Multiple layers of competitive advantage create a sustainable market position.
Every payer, provider, and physician that joins increases value for all participants. More data improves AI accuracy, creating a compounding advantage.
Custom-trained models on medical necessity criteria, InterQual guidelines, and payer policy databases create irreplicable analytical capabilities.
Board-certified physicians across 40+ specialties provide independent peer reviews. This credentialed network takes years to build and maintain.
HIPAA compliance, SOC 2 Type II certification, and binding arbitration frameworks create significant barriers to entry for competitors.
Join Us in Transforming Healthcare Dispute Resolution
We're seeking strategic investment partners who share our vision for a more efficient, fair, and transparent healthcare system.
Reach out for pitch deck, financials, and partnership opportunities.