AI POWERED OVERPAYMENT DETECTION & RECOVERY

At ClaimReturn, we’ve spent years refining a data-analytics and recovery platform built to identify improperly-paid medical claims and recover overpayments. Today, we’ve elevated that capability even further by integrating advanced artificial intelligence — including large-language models (LLMs), retrieval-augmented generation (RAG), and machine-learning analytics — directly into our claim-integrity engine.

While others may use rules engines or limited machine-learning models, our platform combines deep contextual language understanding, document-aware reasoning, pattern detection, and continuous learning into a single, unified system focused specifically on medical overpayment identification and recovery.

This makes our approach not only more advanced — it makes it fundamentally different.

Traditional audits rely on predefined rules and known error patterns.

With the growing complexity of billing, coding, provider contracts and adjudication logic, new forms of overpayment risk emerge constantly.

AI enables us to detect subtle anomalies, interpret claim narratives, understand contextual nuances, and learn from historical patterns — at a scale no manual process can match.

Our AI models are trained specifically around medical claim behavior, we can deliver exceptional accuracy with minimal provider, plan or member abrasion.