Case Study: a mid-sized health plan recovers $24M with Zymr's AI-powered denial prediction platform

a mid-sized health plan recovers $24M with Zymr

The client, a mid-sized health plan, faced significant revenue loss due to high claim denial rates from manual and reactive review processes. They lacked data-driven insights into denial trends and a scalable system to standardize processes across multiple payer contracts. To address these, the organization partnered with Zymr for an AI-powered denial prediction platform.

Zymr developed and deployed a machine learning model trained on historical claims data to identify high-risk claims before submission. The solution was integrated into existing workflows as a real-time scoring API. This implementation by Zymr recovered $24 million in revenue within the first year, achieved a 47% increase in first-pass claim acceptance rate, and reached 91% denial prediction accuracy.