Claims Lack Real-Time Oversight
Claims review happens across fragmented tools
Manual workflows slow down intervention
Transparency data is disconnected from claims
Scaling review requires more headcount
Analytics lag by months, not actionable in the moment
No real-time visibility into claims decisions
Site of care choices happen without employer context
Fiduciary responsibility without fiduciary-grade tools
BenOsphere helps TPAs triage and negotiate claims at scale using AI and price transparency data, giving employers fiduciary-grade oversight and measurable savings.
A Claims Triage and Negotiation Platform
100% Claims Triaged
Reviews claims for pricing issues, unbundling, upcoding, and duplicate charges.
Price Transparency
Benchmarks billed amounts against payer and hospital price data.
Focused Intervention
Only claims with real savings potential are routed for negotiation or action.
Real-Time Oversight
Employers and TPAs see claims in progress and savings impact in real time.
Claims Intelligence Powered by AI Agents
Every claim reviewed, triaged and documented before payment.
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Mira
Reviews every claim and flags pricing errors, coding drift and billing risks.
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Nina
Prepares negotiation evidence and pricing benchmarks for claim correction.
Theo
Gives Underwriters visibility into claim quality and loss ratio drivers.
Give TPAs and Employers Real Control Over Claims
Operational Oversight
See claims as they move through the system before payment
Cost Exposure Clarity
Identify where claim spend is accumulating and where intervention matters most.
Actionable Prioritization
Focus teams on high-impact claims instead of manual sampling.
Fiduciary-Grade Decisions
Support claims decisions with defensible data and documented rationale.
Claims Savings You Can Prove
Reduce up to
10%
of total medical claims spend through pre-pay triage and intervention
Triage
100%
of claims without adding analyst headcount
Save
>600K
in avoidable spend per 1,000 member lives annually
What Sets BenOsphere Apart
Capability
Real-time claim triage
Pre-payment leakage detection
Price transparency benchmarking
Claim-level intervention
TPA workflow integration
Underwriting risk signals
Simple pricing
Employer claims intelligence
BenOsphere
HealthEdge
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GradientAI
Springbuk
Built on National Price Transparency Data
Uses payer and hospital pricing to validate claims in real time.
Your Questions, Answered
Still have some questions? Don’t worry. Take a look at our FAQ below.
Does this replace our TPA or existing workflows?
How is this different from post-pay audits or reports?
Will this slow claim payments or member experience?
How do you prove savings and stay fiduciary-safe?
How does this support employer fiduciary responsibility?
