Meet your
new
Claims
Audit
Manager.
A digital audit professional who detects utilisation anomalies,
fraud patterns, and behavioural shifts across thousands of claims simultaneously —
with explainable, evidence-backed findings that empower your audit team
to act, not investigate from scratch.
-The Problem
Audit teams are looking for
at every handoff
needles in an ever-growing haystack.
The patterns that indicate fraud or unusual utilisation are often only visible
when thousands of claims are reviewed simultaneously.
Manual sampling, by definition, can't see what's hiding in the data you didn't look at.
Manual sampling misses the signal
Traditional audits review a fraction of claims. The anomalies that matter — subtle shifts in behaviour across a member population — are only detectable at full scale.
High-risk cases aren't prioritised
Without intelligent scoring, audit teams spend equal time on routine claims and genuinely suspicious ones. The result is effort applied where it matters least.
Findings lack clear reasoning
Even when anomalies are found, articulating why a case is suspicious — in a way that supports action or escalation — requires significant manual analysis and documentation.
Fairness and isolation concerns
Comparing member behaviour across different client populations introduces fairness risks. Patterns that are normal in one context can appear anomalous in another.
50%
3×
40%
↑ Detection
Faster RFQ turnaround
Manual follow-ups needed
100%
Zero
Full lifecycle audit trail
of broker admin time is
coordination overhead
longer quote cycles
when follow-ups
are manual
of RFQs experience at
least one missed
carrier response
A digital
manager who
sees
the patterns
humans can't at scale
The Zentis Claims Audit Manager analyses every claim in a portfolio — not a sample — evaluating frequency shifts,
provider spread, diagnosis variability, and member-level utilisation changes.
It does this within each client's population in isolation, ensuring fairness and preventing cross-portfolio contamination.
Critically, it makes no medical judgements and no claim denials.
It surfaces prioritised, explained findings so your audit team can focus their expertise
where it genuinely matters.
-The Solution
-What It Does
From raw claims data to
prioritised audit intelligence.
Every step from data ingestion to interactive reporting — handled with
transparency, fairness, and full explainability.
Validates and structures data
Ingests claims data, validates completeness and integrity, and structures it for analysis — ensuring downstream findings are built on clean, reliable foundations.
Analyses every claim, not a sample
Evaluates frequency shifts, provider spread, diagnosis variability, and utilisation changes across the full member population — within each client's isolated data environment.
Prioritises audit workload
Generates plain-language justifications for each flagged case — outlining specifically what changed, over what period, and how it compares to population norms.
Explains every flagged finding
Triggers nudges and escalations based on due dates and carrier behaviour patterns. Brokers are alerted only when a situation needs their judgment — not their time.
Delivers interactive dashboards
Provides audit teams with live, filterable dashboards alongside JSON feeds and audit-ready PDF reports — giving every stakeholder the format they need.
Maintains client data isolation
Each client's claims data is analysed independently. Cross-client pattern comparison never occurs — ensuring fairness and protecting client confidentiality.
-Expected Impact
What changes when auditors
work from intelligence, not instinct
Measurable outcomes from day one of deployment.
Improved detection of unusual utilisation patterns Full portfolio vs sampled review
↑ 70%
Clear
100%
Prioritised, risk-ordered audit workload Normal / Monitor / Review categories
Explainable member-level findings Plain language, ready for documentation
Client-wise data separation Fairness enforced by design
Isolated
Enterprise-grade by design
-Security & Compliance
Deviprasad Thrivikraman · Managing Director, Zentis AI
30+ years in global BFSI operations
30+ years in global BFSI operations
Built to meet the security, privacy, and compliance requirements of
regulated financial institutions from day one.
SOC 2 Certified
GDPR Compliant
BCBS 239 Ready
On-Premise Deployable
Air-Gapped Environments
LLM-Agnostic
Cloud-Agnostic
Full Audit Logging