Payment integrity is undergoing a structural reset. Plans are moving from retrospective "pay and chase" audits to pre-payment validation powered by AI, predictive analytics, and automation. The vendor landscape is fragmenting in parallel; specialist innovators are challenging established leaders, while payers rethink whether to insource, outsource, or co-source across claims editing, clinical review, COB, subrogation, and FWA. But how should payer leaders sequence technology, services, and operating-model decisions to lower MLR and reduce provider abrasion without disrupting throughput? This two-speaker session unpacks where the PI market is heading and how plans should position for what's next.
- How AI and pre-payment validation are shifting value from recovery to prevention
- How niche innovators are reshaping vendor selection and the case for unified pre-pay / post-pay platforms
- How payers are restructuring in-house, outsourced, and co-sourced PI to make payment accuracy a strategic advantage
Ankur Verma
Ankur Verma is a member of the Business Process Services team and assists clients on topics related to optimizing business process service delivery models, with an emphasis on Healthcare (payers and providers) and Life Sciences. Ankur’s responsibilities include assisting in managing Everest Group’s Healthcare and Life Sciences Outsourcing subscription offerings and providing outsourcing advisory services to clients on an ad hoc basis.
Prior to joining Everest Group, Ankur was a Senior Analyst with The Smartcube. He holds a bachelor’s degree in technology from Netaji Subhas Institute of Technology, Delhi.
