Data Mining Solution
Uncover overpayments with a data mining solution that combines advanced analytics and healthcare expertise to identify high-value opportunities, improve recovery precision, and reduce unnecessary provider friction.
Turn claims data into measurable savings
Health plans generate massive volumes of claims data — but finding meaningful errors within it is a challenge. Traditional approaches can miss subtle patterns, create false positives, and require significant manual effort.
Carelon turns complex claims data into actionable insights through advanced analytics, proprietary algorithms, and clinical expertise to identify overpayments quickly and accurately.
Our approach helps you:
- Detect improper or potentially fraudulent claims
- Reduce claims leakage across lines of business
- Minimize administrative burden
- Improve recovery rates with greater precision
The result: more potential savings, less noise, and better alignment with providers.
Lines of business:
- Commercial
- Medicare
- Medicaid
- Federal employee
Audience:
- Payers
Solve the biggest data mining challenges
Find what others miss
Surface hidden patterns and detect anomalies across large, complex datasets using advanced healthcare claims analytics.
Reduce false positives
Focus on high-confidence opportunities to minimize unnecessary provider abrasion and rework.
Accelerate time to recovery
Quickly identify and route overpayments so your team can act faster and capture more value.
Strengthen provider relationships
Use transparent, data-driven insights to support fair and accurate claim reviews.
Inside our Data Mining Solution
What’s built into the solution matters — and so does how well it fits your organization. Carelon brings data mining capabilities together in a flexible and scalable solution designed around your organization’s policies, workflows, and payment integrity priorities.
Advanced analytics platform
Detect anomalies and improper payments
Secure data environment
Ingest and manage claims data with confidence
Collaborative workflow tools
Streamline review and recovery efforts
Real-time dashboards and reporting
Track program performance and ROI
Experience that strengthens every opportunity
Decades of payment integrity work, extensive claims experience, and a dedicated team help Carelon find more opportunities, recover more value, and strengthen payment integrity performance.1
How our Data Mining Solution works
Collect
Securely ingest and normalize healthcare claims data across systems and lines of business.
Analyze
Apply advanced algorithms and healthcare-specific models to identify anomalies, errors, and potential overpayments.
Prioritize and route
Surface high-value opportunities and route them efficiently for validation and recovery.
Optimize
Continuously refine models and strategies using performance insights to improve accuracy and results over time.
Gain clarity, control, and visibility into ROI
With Carelon’s Data Mining Solution, you gain visibility into payment integrity performance through dashboards and reporting that help you:
- Track savings and recovery outcomes
- Understand drivers of improper payments
- Identify opportunities for continuous improvement
With transparent performance insights, your team can demonstrate ROI, refine strategies, and make more informed payment integrity decisions.
Explore related solutions
Connect with our payment integrity experts
Contact us to explore the potential impact of our Data Mining Solution for your health plan.
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1 Carelon internal data, 2025.