Claritev's Business Segments

Claritev Corporation, founded in 1980, is a technology, data, and insights company focused on the U.S. healthcare system. It combines over 45 years of claims experience with advanced technology and artificial intelligence to provide market-based insights into healthcare costs, pricing, and payment dynamics. Claritev offers solutions aimed at improving alignment between payers and providers, reducing unnecessary spending, and enhancing billing and payment accuracy. Its platform integrates technology, data, and insights across the healthcare ecosystem and serves more than 750 clients, including payers, employers, and plan sponsors, with access to over 60 million consumers. The company's offerings include Claims Intelligence Solutions, Network Solutions, Payment and Revenue Integrity Solutions, and Data and Analytics Solutions, which support detection of anomalous claims, provider network management, identification of improper charges, and benefit plan optimization. Claritev's platform primarily operates pre-payment to facilitate efficient claims processing and cost management. The company estimates its total addressable market at approximately $30 billion across its solution areas.

Claritev serves multiple market segments, including Commercial Healthcare Payers, Third Party Administrators, Employers, Brokers/Consultants, Providers, Government Healthcare Payers, and System Integrators. Its solutions encompass Claims Intelligence, Network, Payment and Revenue Integrity, and Data and Analytics, available throughout all 50 U.S. states and the District of Columbia. The Commercial Healthcare Payers segment comprises fully-insured and self-insured health plans, with self-insured plans accounting for over 84.5% of Claritev's projected 2025 revenues, serviced through payers or directly. This segment also includes individual health plans supported by insurance companies but not sold directly to individuals. The Government Healthcare Payers segment includes Medicare, Medicaid, TRICARE, Federal Employees Health Benefits, Veterans Administration, and other federal health programs, with many commercial healthcare services applicable to these payers. Medicare Advantage plans represent a significant portion of this segment, with enrollment estimated at 34.1 million in 2025, more than doubling over the past decade.