Healthcare Claims Processing
Wherever claims flow between providers and payers, human judgment still wins.
We’ve adjudicated claims across policy types. Consistent across processors and policy exceptions. Your complex exceptions aren’t complex to us.
Claims intake, validation, adjudication, payment—the volume is relentless and the rules are complex. Automation handles routing, but it can’t resolve the exceptions, ambiguities, and edge cases that determine accurate payment.
Before you outsource anything, we’ll walk through your current operations with you and assess:
Where automation genuinely helps
Where human judgment is required
Whether outsourcing makes sense & how to do it cleanly
The Real Problem
Most teams don’t struggle to receive claims. They struggle to adjudicate them accurately and efficiently.
Automation generates speed, but it also generates risk
Auto-adjudication rules miss nuanced policy exceptions
Member eligibility gaps create payment errors
Provider contract variations require manual interpretation
Appeals and disputes pile up without systematic resolution
When payment accuracy affects both members and providers, “processed” isn’t the same as “processed correctly.”
Where Human-Led Operations Still Win
Claims Intake & Validation
Claims Adjudication Support
Exception & Edge Case Handling
Appeals & Dispute Resolution
Quality & Compliance Review
Your Operations May Be Different—That’s Fine
Most of our client work is bespoke. The categories above reflect our core expertise, but we’re always open to custom requirements. If your operations share the same fundamentals—high volume, real stakes, and the need for human follow-through—we should talk.
What Assivo Actually Does
Assivo provides managed claims processing operations, with 99.7% accuracy rates, dedicated teams across four global offices, and fixed-price structures aligned to outcomes.
We take ownership of:
Process Design & Documentation
Dedicated, Trained Offshore Teams
Multi-layer Quality Assurance
Clear SLAs, Reporting, & Escalation
Strategic Human-in-the-Loop Governance
Automation scales the work. Humans own the result.
Three principles guide every engagement
Humans where policy interpretation, appeals, and exceptions require judgment
Automation where routing and rules-based adjudication make sense
Clear ownership when something breaks
Quiet execution. Clear ownership. No surprises.
Why Assivo
Founded in 2017, Assivo applies the rigor of institutional finance and strategy consulting to outsourced operations, with a focus on clear accountability, fixed-price commercial structures, and outcome-oriented delivery. As an independent, privately held firm, Assivo structures partnerships around client priorities, emphasizing continuity, transparency, long-term relationships, and client integrity.
Accuracy-first Execution
Every deliverable passes through multi-layer quality review before it reaches you. We measure in defect rates, not just throughput.
Strategic Human-in-the-Loop Governance
Automation handles volume. Human judgment handles exceptions, edge cases, and the decisions that affect outcomes.
Managed Teams, Not Seat-based Staffing
You get a trained team that learns your processes, not a rotating pool of contractors. Our annual turnover is ~15%—a fraction of the 50% industry average. Continuity drives quality.
Offshore Efficiency, Onshore Standards
Our global teams operate under U.S.-caliber management, documentation, and accountability structures.
Clear Accountability from Intake to Output
One point of contact. Defined SLAs. Transparent reporting. When something goes wrong, you know who owns the fix.
Trusted by America’s Leading Operators
Before you outsource anything, we’ll walk through your current operations with you and assess:
Where automation genuinely helps
Where human judgment is required
Whether outsourcing makes sense & how to do it cleanly