The Challenge
A healthcare cost-containment company helps self-funded employer health plans manage the cost of specialized, high-cost care. Claims arrive from multiple third-party administrators, analysts reprice them against contracted and reference rates, and clients receive reports showing the savings achieved. Clinical staff review cases alongside the claims team.
The company’s legacy setup could not keep up with that workflow, and it had no in-house technology leader to plan what came next. Technology was at the core of the operation and key to its growth, but a full-time executive hire was not the right fit.
The company needed to:
- Accept electronic claims from multiple administrators reliably.
- Give analysts, reviewers, and managers a structured repricing workflow.
- Produce clear savings reports for clients, at volume.
- Get senior technology strategy and vendor oversight without a full-time CTO.
The Approach
BRIO started with the fundamentals: migrating the existing claims system, then running vendor selection and discovery before recommending a custom platform built around the company’s specific workflow. The platform was wireframed with the people who use it, built in phases, and has been enhanced continuously since.
In parallel, BRIO took on a part-time CTO role, providing technology strategy, roadmap planning, vendor management, and oversight each month. Two tracks now run side by side: fractional leadership that sets direction, and a delivery team that builds it.
The Solution
Electronic Claims Intake: Standard electronic claim files arrive through secure, per-administrator transfer folders and are loaded automatically, so adding a new administrator is a configuration task rather than a rebuild.
A Structured Repricing Workflow: Claims move through validation, clinical review, and audit review, with bulk actions for high-volume work and integration with a third-party repricing service.
Savings Reports at Volume: The platform generates repricing and savings analysis reports as PDFs and delivers them to clients in bulk.
Oversight Built In: Role-based access separates administrators, managers, and analysts. Dashboards track financial rollups, analyst throughput, and turnaround time, and alerts flag gaps in treatment and unusual pricing deviations.
Prospect Analysis: A reporting pipeline analyzes employer claim files to identify relevant cases by diagnosis and procedure codes, producing summary reports that help the company scope new client opportunities.
Continuous Enhancement: Recent work added claim status tracking, follow-up reminders, member record merging, summary and detail reporting, and generation of monthly billing files.
Fractional Technology Leadership: As part-time CTO, BRIO guides technology strategy, security reviews, vendor decisions, and administrator onboarding, so the company has senior leadership in the room without a full-time executive.
Technical foundation
- .NET web application with SQL Server on Azure
- Electronic claims processing with secure file transfer
- Integration with a third-party repricing service
- Automated PDF reporting and bulk delivery
- SQL-based analytics pipeline for claims analysis
- Role-based access, dashboards, and alerting
The Impact
The company runs its core business on a platform built for it:
- More than six years of continuous partnership across platform and leadership work.
- Claims from multiple administrators flowing into one structured workflow.
- Savings reports produced at volume rather than assembled by hand.
- Senior technology leadership without a full-time executive hire.
For a specialized business, off-the-shelf software rarely fits and a full-time CTO is not always the right first move. Pairing a purpose-built platform with fractional leadership gives the company both the system and the strategy.
