80+ combined years in health-plan IT·In production since 2023·40–60% lower admin cost·ROI within 90 days
Who built this
CareInsight is built by technology leaders who ran health plan operations — we know the frustration your systems cause.
Who we serve
The most operationally demanding line of business in healthcare.
- Star ratings dictate revenue.
- CMS deadlines govern every authorization, appeal, and grievance.
- Audit readiness means organized medical records, clinical criteria, and tracking.
- SNPs raise the bar further: Model of Care commitments turn HRA completion, Individualized Care Plans, and Interdisciplinary Care Team documentation into scored, audited obligations — while enrollment growth outpaces coordinator capacity.
A compliance matrix unlike any other payer.
- State-specific contract requirements and EQRO reviews.
- Encounter-data standards and quality withholds tied to measures.
- Redetermination obligations.
- The hardest-to-reach population in healthcare — members who change phones, move often, speak dozens of languages, and carry social risk factors claims data will never reveal.
A paradox the health-tech industry ignores: the same obligations as a full medical carrier, on a fraction of the staff.
- UM turnaround and A&G timeliness.
- Member notification requirements.
- State and CMS compliance across Medicaid and MA.
The most demanding seat in managed care: delegated administrators inherit the plan’s exposure.
- CMS and state compliance obligations.
- Audit exposure and timeliness clocks.
- All at margins and staffing far leaner than the plans that delegate to you — and every year, delegation oversight audits get tougher.
Shared savings are earned in the gaps.
- Spotting rising-risk patients before the claims show it.
- Engaging them between encounters.
- Documenting quality without drowning clinicians in admin work.
The renewal is won on experience and trend.
- Your call center is your highest member-facing cost.
- Your chronic populations drive next year’s trend.
- Your account teams need outcomes to show — not activity reports.
We understand health plan operations
We speak Stars, HRAs, risk adjustment, and A&G clocks — not just models and tokens.
Proven in production, at scale
Our agents are already absorbing real operational volume, and the platform scales from 10,000 to 500,000+ lives without proportional hiring.
Start small, expand with proof
The path is Agent → Product → Platform. Start with the one agent that pays back fastest, prove the ROI on your own numbers, then expand naturally — no big-bang commitment.
Low risk by design
We work inside the systems you already run, keep clinicians in the loop, and stay compliant by architecture — so modernizing operations never means betting the plan.
Measurable ROI, not promises
40–60%
Lower admin cost
per member
per member
90
Days to ROI
on your own numbers
on your own numbers
70%
Less chart-review time
with one record
with one record
