Lumelight’s Claims Audits combine clinical insight, data precision and human perspective to ensure every claim is processed accurately, fairly and in line with plan intent.
Before (or soon after) claims begin to process, Lumelight’s Implementation Audits validate system setup and plan configuration to ensure accuracy from day one. The review identifies discrepancies early, protecting plan integrity, reducing costly rework and supporting a smooth launch.
Lumelight’s Medical and Prescription Drug Claims Audits independently evaluate carrier and TPA performance. Through detailed analysis across eligibility, coding, pricing, and payment, we uncover errors, identify opportunities for recoveries, and help clients strengthen every aspect of plan administration.
Audits tailored to each plan confirm that claims are paid correctly, supported by policy and aligned with contractual terms.
Findings are clear, prioritized and immediately actionable—empowering teams to correct issues and strengthen processes.
Lumelight works directly with carriers, TPAs and consultants to resolve discrepancies and preserve relationships built on transparency.
Automated tools and repeatable processes make ongoing reviews efficient and scalable as plans change and grow.
Lumelight’s impartial review process provides objective insight into carrier and TPA performance, ensuring every audit outcome is fair and verifiable.
Audits consistently uncover recoverable savings while reinforcing accountability across every stakeholder.
See how leading employers use Lumelight’s Claims Audits to strengthen oversight and reduce errors. From system validation to post-implementation accuracy checks, each story demonstrates the impact of continuous improvement in plan governance.
Lumelight experts share perspectives on audit best practices, plan governance and performance improvement, helping organizations align accuracy, accountability and care.
Lumelight helps employers manage plan accuracy with care and precision, so every claim supports the health, trust and performance of their organization.
We handle the complexities of benefits compliance and administration, empowering you to focus on what you do best.
