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

a mid-sized health plan recovers $24M with Zymr's AI claims platform

The client, a mid-sized health plan, faced operational complexity and financial losses due to reactive claims processes, rising denials, and limited visibility into revenue-cycle performance. To address these challenges, the health plan partnered with Zymr to build an AI-powered claims intelligence platform.

Zymr implemented a platform featuring AI-based denial prediction models and claims workflow automation. This solution delivered a 91% claim denial prediction accuracy and recovered over $24 million across 4.1 million claims. The implementation by Zymr also resulted in a 35% reduction in manual review effort and 28% faster claims processing cycles.