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Claims Intelligence
AI-powered anomaly detection • Real-time analytics • Deep drill-down
4.5%
$8.25M
Total Claims YTD
8.2%
45,892
Claims Volume
12.5%
7.2
Avg Processing Days
15.3%
76
Anomalies Detected
Claims Trend
Medical vs Pharmacy spend by month
MedicalPharmacy
Anomalies Detected
AI-flagged claims
Duplicate Claims
23 claims
$45K
Unusual Charges
18 claims
$89K
Pattern Anomaly
12 claims
$34K
Provider Outlier
8 claims
$68K
Timing Anomaly
15 claims
$23K
Claims Explorer
Click any claim to view details and AI analysis
| Claim ID | Member | Service Date | Provider | Procedure | Billed | Paid | Risk | Flags | Action |
|---|---|---|---|---|---|---|---|---|---|
| CLM-2024-78432 | Rodriguez, Maria M-4521 | 2024-10-28 | Memorial Hospital | Hip Replacement | $85K | $58K | 78 | unusual | |
| CLM-2024-78433 | Chen, William M-3287 | 2024-10-27 | CardioHealth Associates | Cardiac Catheterization | $42K | $31K | 45 | — | |
| CLM-2024-78434 | Johnson, Patricia M-7832 | 2024-10-26 | Oncology Specialists | Chemotherapy Administration | $29K | $20K | 82 | pattern | |
| CLM-2024-78435 | Thompson, James M-2156 | 2024-10-25 | Specialty Pharmacy Inc | Ocrevus Injection | $35K | $28K | 91 | duplicate | |
| CLM-2024-78436 | Davis, Robert M-9443 | 2024-10-24 | Dialysis Center | Hemodialysis Session | $3K | $2K | 35 | — | |
| CLM-2024-78437 | Wilson, Sarah M-5521 | 2024-10-23 | Emergency Medical Center | Emergency Room Visit | $8K | $5K | 72 | unusualtiming |