Case Study: a top national healthcare payer improves payment integrity with EXL

a top national healthcare payer boosts payment integrity with EXL, uncovering a 33% findings rate

One of the top national healthcare payers struggled to innovate its payment integrity program due to a traditional vendor ecosystem, legacy processes, and an internal team that could not meet aggressive savings targets. The client partnered with EXL Health to revamp its program with a focus on robust analytics, accurate forecasting, and reducing provider abrasion.

EXL implemented a custom solution using advanced analytics, AI, and machine learning to identify new auditing opportunities and optimize performance. This approach delivered significant improvements, including identifying a 33% findings rate on claims another vendor had cleared. The solution provided substantial ongoing benefits by enabling earlier claims review, replacing outdated processes, and uncovering sizable savings opportunities.