Spearfish surfaces the intelligence inside every claims interaction — across property & casualty, specialty lines, and healthcare — and delivers it to the people who can resolve claims faster, reduce disputes, and fix the process failures driving repeat contacts.
Whether a customer is calling about a totaled vehicle, a denied prior authorization, or a disputed medical bill, the interaction contains signals that go far beyond what the claim record captures.
Most organizations score a fraction of those interactions and use the results to coach agents. The intelligence that should reach claims operations, fraud, clinical review, and member experience teams never leaves the contact center.
It stays invisible — until it surfaces as a complaint, a delayed settlement, or a member who silently walked away.
A three-step pipeline that turns unstructured conversation into prescriptive intelligence — without sampling, and without leaving the work to the contact center.
100% of claims interactions across voice, chat, email, and AI-assisted channels — connected to claims system data, CRM records, and where applicable, clinical or eligibility data. No sampling.
Sentiment trajectory, process deviations, customer and member effort markers, cross-interaction patterns, and adjuster or care advocate behavior signals across every interaction.
Not just what happened — but what should change, who should change it, and what the expected outcome is. Intelligence routed to the team that owns the fix, not the team running the queue.
Spearfish identifies the specific process steps generating repeat contacts and extended resolution times — and delivers that intelligence to the operations team that can fix them.
Cycle time root causes by claim type, coverage line, and adjuster behavior.
Prior auth and appeals patterns; billing dispute root causes; care advocate behaviors that predict first-call resolution vs. escalation.
Structured claim data and billing records don't capture everything. Spearfish surfaces the conversational signals that do — and delivers them to fraud and billing integrity teams before payment is made.
Inconsistency patterns across statements, contacts, and claim records.
Billing anomalies and provider behavior signals surfaced pre-payment.
Pre-complaint and pre-grievance signals are recognizable in hindsight. Spearfish makes them visible early enough to act on — pinpointing the interactions where intervention is still possible.
A status update that sent a customer looking for an attorney.
A denied authorization call that didn't resolve the member's question.
Coverage confusion and benefits misunderstanding don't start in the contact center — they start in how products are designed and communicated. Spearfish surfaces those patterns before they show up in loss ratios or plan performance data.
Policy language driving preventable dispute contacts.
Benefits structure and member comms generating grievances.
In both cases, the intelligence needed to prevent bad outcomes already exists in the interactions themselves. Spearfish makes it usable.
A claims interaction that goes poorly means a delayed settlement, a complaint filing, or a customer who doesn't renew. The cost is measurable — and recoverable, if you catch the signal in time.
A member who can't get a clear answer on a prior authorization may delay or forgo care. A billing dispute that isn't resolved drives not just churn — but genuine harm to the member relationship, and potentially to health outcomes.
Repeat contact rates go down — because the root causes are reaching the people who can fix them, not just the people managing the queue.
Cycle times shortened where the root cause was hiding in the interaction.
Surfaced before payment — not after.
Pre-complaint signals caught while intervention is still possible.
Root causes fixed by the team that owns the process.
A 30-minute working session with a Spearfish solutions engineer — bring a claim type, a contact channel, or a recurring escalation. We'll show you the intelligence you're missing.
