Case · Healthcare · Health plan
Unimed Paraná: 200% more claims audited per month, with the same team
Unimed Paraná, a health plan in Brazil's Unimed cooperative system, was UpFlux's first client. Its retrospective medical claims audit, once manual and bureaucratic, now has every claim reviewed by AI models: low-risk claims are released automatically and auditors focus on the cases that matter.
The problem
Before UpFlux, Unimed Paraná audited medical claims through manual, bureaucratic steps. Qualified professionals spent their day on repetitive checks, which raised the chance of error and wasted the auditors' clinical judgment.
What UpFlux did
UpFlux integrated with the tools the health plan already used and applied automatic denial and release rules on top of that flow. More than 450 AI models scan every incoming claim: low-risk claims are released with no human touch, and high-impact ones reach the auditor prioritized, with the discrepancy already flagged.
The result
The volume of claims audited per month grew 200% with no added headcount. Rules are now applied automatically, errors dropped, and the quality of the physician and nurse auditors' analysis went up.
UpFlux now runs in more than 40 cooperatives of the Unimed System.
“After the rollout, every rule became automated, which cut the number of mistakes. The volume of audited claims went up, and so did the quality of the physicians' and nurses' analysis. Beyond the accounting side, the focus is the quality of patient care, and there the gain was beyond words.”
Your operation is leaving money on the table. Let's measure how much.
In 30 minutes we show how a digital team connects your data, acts inside daily operations and proves the return in hard numbers.