Claims Data Analysis
Understanding where money goes
Deep analysis of claims data to reveal cost drivers, patterns, and opportunities
Why does claims analysis matter?
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Claims represent actual healthcare spending. Understanding claims patterns reveals what's driving costs, who's generating claims, what conditions are prevalent, and where optimization opportunities exist. Without this understanding, cost management is guesswork.
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See where your benefit plan is leaking
Find out what gaps exist — and what you can do without changing your plan.
We'll show you where money is leaking, risks are growing, and what you can fix within your current structure. No pressure to change brokers, carriers, or benefit design. Just clarity.
- Gap analysis based on your actual plan structure
- Clear findings you can share with your broker
- Recommendations that layer on — no disruption required
Cost Driver Identification
Identifying what's driving costs: specific conditions, high-cost individuals, utilization patterns, provider pricing, or facility selection.
Trend Analysis
Understanding how costs are changing over time—improving, worsening, or stable—and what's driving changes.
Utilization Pattern Review
Examining how employees use healthcare: appropriate use of settings, preventive care uptake, emergency room utilization.
Opportunity Identification
Translating analytical findings into specific opportunities for cost reduction or outcome improvement.
What is Claims Data Analysis?
Claims Data Analysis examines healthcare claims to understand spending patterns, cost drivers, and improvement opportunities.
Every claim tells a story—what care was provided, where, by whom, at what cost. Collectively, claims reveal how a population uses healthcare.
Analysis extracts insights from this data: what conditions drive costs, how utilization patterns compare to benchmarks, where waste exists, and what interventions might improve outcomes.
Why Is Claims Analysis So Valuable?
Most employers renew their health plans year after year without questioning the underlying assumptions. Brokers present options, carriers set rates, and leadership approves budgets based on incomplete information.
The result? Companies overpay for benefits employees don't use while missing coverage gaps that create real risk. They accept premium increases as inevitable rather than addressable. They lack visibility into where their money actually goes.
A Healthcare Risk Assessment changes that. It gives you the data and insight to make informed decisions, negotiate from a position of strength, and take control of one of your largest operating expenses.
How It Works
Claims analysis transforms raw data into actionable insights.
Data Extraction
Gathering claims data from TPAs, carriers, or PBMs in appropriate format for analysis.
Analytical Processing
Applying analytical methods: cost stratification, trending, benchmarking, and pattern detection.
Finding Synthesis
Synthesizing analytical outputs into coherent findings with business implications.
Recommendation Development
Translating findings into specific recommendations for cost management or outcome improvement.
When Should Claims Analysis Be Performed?
Analysis is valuable at multiple points:
• Pre-renewal for understanding cost drivers
• Post-renewal for tracking changes
• Quarterly for ongoing monitoring
• When investigating specific issues
• For evaluating program effectiveness
Where Does Claims Data Come From?
Claims data sources vary by arrangement:
• Self-funded: TPAs provide detailed claims data
• Level-funded: Limited claims data typically available
• Fully-insured: Summary data only in most cases
• PBMs: Pharmacy claims separate from medical
Who Benefits from Claims Analysis?
Employers with claims data access:
• Self-funded employers (primary audience)
• Level-funded employers (limited data)
• Those evaluating self-funding feasibility
• Any employer seeking data-driven cost management
See What Our Customers Are Saying
"What could have been data driven, was soon a conversation. Over 3 years with the best coaches, listeners, advisors you could ask for. If Monique didn't have an answer readily, she would note it, research it, and then update you on the answer. Always a positive meeting. Highly recommend!"
— Sue D.
“Our Medical Insurance Premiums were Out of Control! Thanks to Weltrio and their amazing team of healthcare experts, Weltrio is my single most-profitable cost center!”
— Cayuse CEO
Everything You Need to Know
At Weltrio, we are a medically trained team that works with HR and benefits partners at companies of all sizes to improve healthcare quality, reduce risk exposure, and optimize costs. We work within your existing plan structure—providing employers with clarity, trust, and transparency at every step. Whether you're upgrading your benefits plan or building from scratch, we've got you covered.
Is this the same as telemedicine?
No. Clinical support provides guidance and triage, not diagnosis or treatment. We help employees decide when and where to seek care.How many nurses will be assigned to our company?
Assignment depends on your company size and typical utilization. Smaller companies may share a primary nurse with backup coverage. Larger organizations get dedicated teams. Either way, employees experience consistent relationships with clinical professionals who know them.Who answers calls in the middle of the night?
Board-certified nurses from your Weltrio clinical team. We staff night shifts with experienced nurses who have full access to your company's benefits information and employee interaction history. It's not an outsourced answering service.What protocols do nurses use for triage?
Our nurses use evidence-based clinical decision support protocols developed from emergency medicine and primary care best practices. These protocols are regularly updated based on current medical guidelines and are customized for telephone/virtual assessment settings.How much does an unnecessary ER visit actually cost?
Average ER visits cost $2,200 or more—even for minor issues. Add lab work, imaging, or specialist consultation and costs climb quickly. The same conditions treated at urgent care typically cost $150-300, and telehealth visits run $50-75.
