Case Study: a mid-sized health plan recovers $24M with Zymr's AI-powered claims analytics

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

The client, a mid-sized health plan, faced challenges with fragmented clinical and claims data that limited visibility into reimbursement performance, increased denial rates, and slowed revenue cycle operations. To modernize its revenue intelligence, the organization partnered with Zymr to implement an AI-powered revenue cycle intelligence platform.

Zymr developed a modern platform that unified clinical and claims data using FHIR-based interoperability standards and deployed AI-powered denial prediction models. The solution automated claims validation and delivered real-time revenue cycle analytics dashboards. As a result, the health plan recovered over $24 million in reimbursement revenue, achieved a 35% reduction in claims processing time, and saw a 28% reduction in preventable claim denials.