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ClaimDOC

Smarter claims auditing and member advocacy for self-funded employer health plans.

Claims Technology Growth Bootstrapped
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Overview

ClaimDOC is a national medical claims auditing and member advocacy company serving self-funded employer health plans. Founded in 2013 in West Des Moines, Iowa, the company was created to give plan sponsors a cost-effective and sustainable alternative to traditional insurance carriers and provider networks. ClaimDOC combines licensed healthcare professionals with proprietary technology to audit and negotiate medical claims using objective, nationally-benchmarked reimbursement data.

The company's flagship DirectAccess+ platform provides a comprehensive self-funded plan management solution that integrates claims administration, transparent pricing, and member advocacy into a single system. Plans using ClaimDOC report average savings of 25% to 35% compared to traditional plan structures, while members benefit from richer plan designs and lower premiums.

ClaimDOC serves a multi-sided market of employers, health plan members, healthcare providers, insurance brokers, and stop-loss carriers -- all interconnected through its reference-based pricing and advocacy infrastructure.

Products & Services

DirectAccess+

ClaimDOC's flagship self-funded health plan management platform integrating claims administration, transparent claim pricing, member communications, and real-time reporting in a single environment. Enables employers to replace traditional carrier networks with an objective, benchmarked reimbursement model.

Key Features

  • Claims administration and adjudication
  • Nationally-benchmarked reimbursement pricing
  • Member portal and benefit access tools
  • Real-time reporting and plan performance analytics
  • Stop-loss carrier coordination

Target Users: Self-funded employer plan sponsors and their TPAs

Medical Claims Auditing and Negotiation

Licensed healthcare professionals review and audit medical claims using objective, nationally-benchmarked reimbursement standards. The service negotiates fair payment rates on behalf of self-funded employers, reducing inflated provider billing.

Key Features

  • Line-by-line claim review by licensed healthcare professionals
  • Nationally-benchmarked reimbursement standards
  • Direct provider negotiation and settlement

Target Users: Self-funded employer plan sponsors

360 View of Risk

A risk assessment platform analyzing health plan cost drivers and performance from the perspectives of the member, employer, and stop-loss carrier. Provides comprehensive visibility into plan risk and cost trends.

Key Features

  • Multi-perspective risk analysis
  • Cost trend identification
  • Stop-loss coordination support

Target Users: Employers, TPAs, Stop-Loss Carriers

Member Advocacy

Dedicated member advocacy services ensuring plan participants receive fair treatment, transparent pricing information, and effective navigation of the healthcare system.

Key Features

  • Member support and issue resolution
  • Benefit navigation assistance
  • Provider billing dispute advocacy

Target Users: Health plan members

At a Glance

Founded
2013
Headquarters
West Des Moines, Iowa, USA
Employees
51-200
Funding
Bootstrapped

Category & Focus

Category
Claims Technology
Subcategories
Medical claims auditing reference-based pricing member advocacy self-funded plan management
Insurance Verticals
Health Group Benefits
Target Customers
Employers, TPAs, Brokers, Carriers

Customers

  • Self-funded employer plan sponsors (primary)
  • Insurance brokers and consultants distributing ClaimDOC solutions
  • Stop-loss reinsurance carriers coordinating on large claims

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Last updated: 2026-04-09