Healthcare Payer

AI-Powered Payer Recovery

From data intake to recovery execution — Lumi agents identify, validate, and recover overpayments across 10 recovery types including subrogation, COB, duplicate payments, and contract audits with full policy compliance.

Launch Interactive Demo See How It Works

Recovery Queue

Live

Identified

In Progress

$847K

Recovered

REC-2847

Duplicate Payment — $47,200 identified

Identified

REC-2845

COB Primary — Other coverage found

Identified

REC-2841

Subrogation — Auto accident claim

In Progress

REC-2839

Contract Audit — Rate variance 12%

In Progress

REC-2835

Workers Comp — $23,400 recovered

Recovered

Agentic Intelligence

10 recovery types.
One intelligent platform.

Healthcare payer recovery is complex — subrogation, COB, duplicate payments, contract audits, workers comp, and more. Lumi agents reason through every recovery opportunity with multi-source evidence and policy compliance.

$847K

Recovered in demo scenario

Duplicate Payment Detection

Identifies duplicate payments across claims, providers, and time periods using fuzzy matching and payment pattern analysis.

$47K avg. recovery

Subrogation Recovery

Identifies third-party liability cases — auto accidents, workers comp, liability claims — and initiates recovery from responsible parties.

3rd party detection

COB Recovery

Automatically identifies primary/secondary payer conflicts, other coverage, and coordination of benefits opportunities for recovery.

Multi-payer analysis

Contract Audit

Compares paid amounts against contracted rates, identifying rate variances, fee schedule errors, and underpayment patterns.

Rate variance >5%

Workers Comp Recovery

Detects workers compensation cases that were incorrectly billed to health insurance, initiating recovery from WC carriers.

$23K avg. recovery

Communication Generation

Auto-drafts recovery letters, demand notices, and follow-up correspondence with proper legal language and compliance requirements.

Policy compliant

The Challenge

Recovery operations are broken

Payer recovery teams struggle with fragmented data, manual case building, and complex policy requirements. The result: missed recovery opportunities, compliance gaps, and revenue left on the table.

Today

Fragmented, manual, and reactive

Recovery opportunities discovered months after payment

Evidence gathered manually from multiple disconnected systems

Policy compliance verified manually for each recovery type

No unified view across subrogation, COB, and other recovery types

With Lumi

Unified, intelligent, and policy-compliant

AI agents identify recovery opportunities across 10 types in real-time

Multi-source evidence automatically gathered and validated

Policy compliance verified with guardrails at every step

Unified pipeline from identification to recovery completion

How It Works

A six-stage recovery pipeline

Lumi agents process each recovery opportunity through a structured pipeline — gathering evidence, validating policy compliance, and executing recovery with full documentation.

Data Intake

Claims data ingested from multiple sources and normalized for analysis

Reconciliation

Cross-reference payments, identify duplicates, and detect anomalies

Policy Analysis

Validate recovery opportunity against policy rules and compliance requirements

Resolution

Determine recovery action, calculate amounts, and prepare case file

Communications

Generate demand letters, follow-up notices, and recovery correspondence

Complete

Recovery finalized with full audit trail and compliance package

Agents at Work

A team of specialized agents

A team of specialized agents — each with a distinct role — working in concert to identify and execute recoveries end to end. Powered by Kestrel's reasoning engine with full traceability.

Recovery Identification

Scans payment data across 10 recovery types — subrogation, COB, duplicates, contract audits — surfacing opportunities automatically.

Multi-Source Evidence

Gathers evidence from claims systems, payment records, third-party data, and external sources to build comprehensive recovery cases.

Real-Time Pipeline

Tracks every recovery across all six stages with live status updates, bottleneck detection, and SLA monitoring for the entire work queue.

Communication Generation

Auto-generates demand letters, follow-up notices, and recovery correspondence — with correct legal language and compliance formatting.

Policy Guardrails

Enforces recovery policy compliance, member protection rules, and regulatory requirements at every step — with automatic escalation on violations.

Recovery Analytics

Surfaces recovery rates by type, aging trends, win rates, and dollar recovery metrics — giving leadership actionable visibility into recovery operations.

Use Cases

Where Lumi excels

Built for the real-world complexity of healthcare payer recovery operations — not toy demos.

Subrogation & Third-Party Liability

Identify auto accidents, workers comp, and liability cases where third parties are responsible — automatically initiating recovery from responsible parties.

COB & Duplicate Payment

Detect coordination of benefits opportunities and duplicate payments using pattern analysis and cross-referencing — recovering overpayments at scale.

Contract Audit & Rate Variance

Compare paid amounts against contracted rates, identifying fee schedule errors, rate variances, and provider underpayments for recovery.

Fraud Detection & Prevention

Identify suspicious patterns, billing anomalies, and potential fraud indicators — escalating high-risk cases with full evidence packages.

AI-Powered Payer Recovery

10 recovery types.One intelligent platform.

Recovery operations are broken

A six-stage recovery pipeline

A team of specialized agents

Where Lumi excels

See it in action

10 recovery types.
One intelligent platform.