Healthcare Claims Audits

Make Every  Claim Count

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.

Our Claims Audit Solutions

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.

Built for Better Oversight

Accuracy that endures

Audits tailored to each plan confirm that claims are paid correctly, supported by policy and aligned with contractual terms.

Insight that drives action

Findings are clear, prioritized and immediately actionable—empowering teams to correct issues and strengthen processes.

Collaboration that builds trust

Lumelight works directly with carriers, TPAs and consultants to resolve discrepancies and preserve relationships built on transparency.

Governance that evolves

Automated tools and repeatable processes make ongoing reviews efficient and scalable as plans change and grow.

Independent perspective

Lumelight’s impartial review process provides objective insight into carrier and TPA performance, ensuring every audit outcome is fair and verifiable.

Results that matter

Audits consistently uncover recoverable savings while reinforcing accountability across every stakeholder.

Proof in Practice

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.

Real-Time Dependent Verification Integrated Into The Enrollment Experience

Ensuring Accuracy and Accountability: The Role of Medical Claims Audits in Union Health Plans

From the Lumelight Lens

Lumelight experts share perspectives on audit best practices, plan governance and performance improvement, helping organizations align accuracy, accountability and care.

Post-Implementation Audits: How Medical & Prescription Reviews Protect Plan Sponsors

Post-Implementation Medical Claims Audit Identifies TPA Mistakes

Experience The Benefits of Seamless Integration with ADP Workforce Now®

Why Every Plan Sponsor Needs a Medical Claims Audit: 30 Categories of Risk Exposed

How Traditional Dependent Eligibility Verification Audits Fall Short

Winter Brought Us Snow and a Flurry of Activity Around Pharmacy Benefit Managers

A variety of recent developments and regulations have made Pharmacy Benefit Mangers (PBMs) a particularly hot topic in the benefits compliance space across the past few months. In this month’s blog post, we provide an overview of both the real and proposed changes to the PBM landscape that employers should be mindful of when considering their relationships with these vendors and fulfilling their fiduciary duties.

By the Numbers

medical + Rx Claims Audits conducted

0 +

years of combined audit expertise

Millions

in verified recoveries for employer plans

Focus on What Matters Most

Lumelight helps employers manage plan accuracy with care and precision, so every claim supports the health, trust and performance of their organization.

Healthcare Claims Audits

Make Every  Claim Count

Our Claims Audit Solutions