InsurTech · For insurers, TPAs and payers
Lower loss ratios, proved on your own claims.
Averra is designed to work inside your insurance, under your brand. It checks every claim before and after payment, and arranges care early so avoidable cost never arrives. Every saving is measured on your claims and signed off by your actuary, and fees come only from those savings.
- No saving, no fee
- Starts on your historical claims, with no member contact
- Health data never used for price, cover or claims
- People make every clinical and fraud decision
For each seat at the table
What each of your leaders needs to see.
Finance, claims, medical and risk each carry a different part of the problem. Here is how Averra answers each one.
Finance and actuarial
The problemMedical cost trend outpacing premiums
How Averra answersTwo levers on cost: claims that should not be paid, and costs that should not arrive.
The problemVendor savings you cannot check
How Averra answersSavings measured on your claims and signed by your actuary, with full audit rights and a true-up. No saving, no fee.
The problemWellness programmes that cannot prove their worth
How Averra answersPrevention measured against a risk-matched control group, never assumed.
Claims and payment integrity
The problemLeakage found after the money has gone
How Averra answersFindings traced to the claim line, so your team can act before payment as well as recover after it.
The problemFraud that hides in volume
How Averra answersEvery claim checked on arrival, and patterns across providers, members and time surfaced as cases your investigators can act on.
The problemClaims backlogs and slow turnaround
How Averra answersClean claims flow straight through. The rest arrive with the reason and the evidence, so reviewers decide faster.
The problemProvider friction from audits and disputes
How Averra answersRisk-adjusted against your case-mix, so you challenge an expensive provider, not an expensive population, with evidence in hand.
Medical
The problemMembers unseen between check-ups, and left to find care alone
How Averra answersA twin that watches seven areas of health every day, then care arranged the moment something changes: the doctor, and the right place for any test, scan or therapy.
The problemHigh-cost medicines and chronic disease
How Averra answersPrescriptions without a supporting diagnosis flagged, and metabolic and cardiovascular change spotted early.
Risk and service
The problemGrowing scrutiny of AI
How Averra answersEvery decision explainable and logged; people make every clinical and fraud decision; clinicians own every threshold.
The problemMember trust
How Averra answersHealth data never used to set a price, decide cover or assess a claim. That promise is what makes members connect.
The problemCall-centre and care-management capacity as the ceiling
How Averra answersPrime Assist, our AI assistant, handles customer service, outreach, booking and aftercare on phone and messaging, in any language, so growth is a contract, not a hiring plan.
Two levers
Pay only what should be paid. Stop the cost arriving.
Most tools see a problem only after the claim is paid. Averra works on both sides of the claim: the bills you receive, and the members behind them.
Lever one · claims intelligence
Find the leakage in your history
Risk-adjusted analysis of your claims separates an expensive population from an expensive provider, and finds what should not have been paid. It is measured first on historical claims, before a single member is enrolled.
Lever two · the member twin
Catch deterioration while care is simple
Each member’s twin watches seven body systems, confirms a change with a home test and routes the member to a licensed doctor before the cost arrives. It is measured against a risk-matched control group.
Inside your insurance, under your brand
Seamless for members. Fully visible to you.
Averra is designed to run in the background of your insurance or your administration. It arranges care, prepares pre-approvals, checks claims and explains every payment, so members stop browsing network lists and chasing approvals. Your rules, your network and your people stay in charge.
01 · Arrange
Care, set up for the member
A member mentions a symptom, or their twin notices a change. Prime Assist sets up a licensed doctor and, if the doctor advises it, chooses the right place in your network: high quality, fair price, right for the need, available soon.
02 · Prepare
Pre-approvals, ready
The pre-approval is assembled from the member’s own record and your criteria. Clear requests that meet your criteria can be approved at once. Everything else goes to a licensed clinician, with the evidence.
03 · Pay
Claims, checked and explained
The claim is checked against the pre-approval, your benefits and your contracted tariff, then paid with the reason for every amount.
04 · Record
Every step, on the record
Every step is logged with its rule version and evidence, ready for audit.
What stays with you
- Clinical decisions. Licensed clinicians decide on medical necessity. Software never does.
- Your rules. You set the criteria, network and tariffs. Averra applies them and shows its working.
- Member choice. Members can always choose another provider in your network, and see why one was suggested.
- The pace. It starts in the back office, and goes further only when savings are signed.
- A member on WhatsApp has knee pain. Prime Assist confirms their cover in the member record, books a video call with a licensed doctor for 18:30 in the provider diaries, and saves the conversation with its reasons.
- A member’s doctor has advised an MRI. Prime Assist compares places in the provider network on quality and price, offers a highly rated centre, moves the appointment after work when asked, checks the insurer’s criteria, records the pre-approval in the claims system and saves the reasons.
- A clinic calls about a payment. Prime Assist checks the claim in the claims system, emails the remittance from payments with the reason for every amount, and saves the call.
- A member is worried about a result. The insurer’s rules say a clinician should talk it through, so Prime Assist connects the on-call clinician, who joins with the transcript.
Lever two, illustrated
A member’s journey, before the claim.
What prevention looks like when it is continuous, confirmed at home and explained.
Week 1
A quiet drift
A member’s readings move away from their own baseline.
Then
Confirm at home
Prime Assist sends a home test kit to the member’s door.
Next
A doctor, arranged
A licensed doctor consultation set up, with the result explained in the member’s language.
If needed
The right place
Any test, scan or therapy booked at the right provider in your network, or at home.
Outcome
Before the claim
Care while it is still simple, measured against a matched control.
Illustration of the intended member journey.
Your whole book, by risk.
Members are stratified with an established, internationally used case-mix methodology, in the language your actuaries already use. Every tier gets the intervention that fits it.
- High
Coordinated care
For members with several chronic conditions.
- Medium
Disease management
For a single condition or a set of risk factors.
- Low
Prevention and education
Keeping healthy members healthy, at low cost.
What we find
Five sources of leakage, each traced to the claim line.
Each one is measured against your own members’ case-mix, so your team can act before payment or recover after it.
Over-prescription
Medicines prescribed without a supporting diagnosis, including high-cost therapies.
What you can doAuthorisation rules, provider education, recovery
Unnecessary testing
Duplicate and low-value tests and imaging that the case-mix does not explain.
What you can doPathway rules and provider feedback
Provider overcharging
Upcoding, unbundling and tariff breaches, by provider and by pathway.
What you can doPre-payment edits and recovery
Unwarranted variation
The same risk profile treated at a very different cost.
What you can doNetwork steering and contract terms
Fraud and abuse
Services billed but not received, confirmed with members where they consent.
What you can doInvestigation and recovery
Payment integrity
Before the money moves, and after.
Averra checks claims at both ends of payment, and explains every flag with the rule, the evidence and the policy behind it.
Before payment
Stop errors before they are paid
- Cover and eligibility confirmed
- Coding checked against the care given
- Prices checked against contracted tariffs
- Duplicates and overlaps caught
- Prescriptions checked against the diagnosis
After payment
Recover what slipped through
- Patterns no single claim reveals
- Provider outliers, risk-adjusted for case-mix
- Services billed but not received, confirmed with members who consent
- Every recovery traced to the claim line
Fraud, waste and abuse
Patterns across providers, members and time, packaged as cases your investigators can act on.
Every flag explained
The rule, the evidence and the policy behind each finding, so a provider can see why.
Fair to providers
Benchmarks adjusted for case-mix, so you challenge an expensive provider, not an expensive population.
For third-party administrators
Claims made simple. Fraud found first.
Averra is designed to work inside your administration as an agentic layer, under each client’s brand and rules, from pre-approval to payment.
- Straight-through claims. Clean claims flow on; the rest are held with the reason and the evidence.
- Fraud found before payment. Flagged before the money moves, with the evidence attached.
- Calls and messages, handled. Prime Assist answers members and providers, in their language.
- One record for every client. Each insurer’s rules, data and reporting kept apart.
How savings are measured
One signed number for your board.
Savings are measured on your claims, by your rules, and signed off by your actuary before anything is invoiced. No vendor-reported savings. In plain terms: we compare what your claims cost with what they would have cost without Averra, using members like yours as the yardstick. Only the difference your actuary signs counts.
Baseline
Twelve months of your paid claims, risk-adjusted and trended for medical inflation.
Control
A risk-matched comparison group, or a phased roll-out, so regression to the mean and selection are netted out.
Attribution
Savings count only on the tier Averra manages and the claims it flags. Trend, repricing and benefit changes are excluded.
Run-out
Savings counted by date of care (an incurred basis), once late-arriving claims are in, on the same allowance your reserving uses.
Verification
Your actuary, or a reviewer you nominate, signs the statement. A disputed line is resolved before it is invoiced.
Reporting
A statement in your format, with an annual true-up and clawback of anything later reversed.
What you see
Outcomes and evidence, not members’ data.
A stratified book from month one, flagged claims and provider variance every month, and a savings statement your own team has signed.
Starting small
Add scope only when savings are signed.
Every phase is gated on a signed result from the one before. Nothing is asked of your members until phase two, and every later phase is your decision.
Retrospective review
Your historical claims only. No members involved.
GateSavings agreed with your actuary
Opt-in cohort
Consented members, invited in your brand, against a risk-matched control.
GateA signed savings statement
Book-wide offer
Averra offered to every member as part of their cover, by agreement.
GateEngagement and savings targets met
Delegated authorisation
Averra prepares pre-approvals on agreed pathways. Clear requests that meet your criteria can be approved at once; licensed clinicians decide everything else.
GateTurnaround and appeal rates agreed
Administration support
Agreed administration functions, if and when you choose.
GateService levels met over time
Phase one, in practice
- What we need
- Twelve months or more of paid claims at line level, your benefit tables and policy wordings, provider contracts and tariffs, and pre-approval records.
- How it reaches us
- A secure transfer under a data processing agreement. Nothing connects to your live systems.
- Who joins from your side
- A claims or payment integrity lead, an actuary, a data contact and your information security reviewer.
- What you receive
- Findings by leakage type and provider, each traced to claim lines; a savings estimate built on the measurement protocol; and the checks we would switch on before payment.
- How long
- A fixed timetable, agreed before any data is shared.
Where Averra sits
Others hold one slice of the loop. Averra connects it.
Payment integrity vendors see claims. Voice agents see conversations. Health programmes see one condition. Averra is built to connect the member, the test, the conversation and the claim.
| Capability | Averra, by design | Payment integrity | AI voice agents | Condition programmes |
|---|---|---|---|---|
| Payment integrity and fraud detection, before and after payment | Designed in | Typical | Not typical | Not typical |
| Faster claims for administrators | Designed in | Partly or sometimes | Not typical | Not typical |
| Care arranged and pre-approvals prepared for the member | Designed in | Not typical | Partly or sometimes | Partly or sometimes |
| A continuous signal from each member | Designed in | Not typical | Not typical | Partly or sometimes |
| Confirmation with an at-home test | Designed in | Not typical | Not typical | Partly or sometimes |
| Escalation to licensed clinicians | Designed in | Not typical | Partly or sometimes | Typical |
| The whole person, not one condition | Designed in | Not typical | Not typical | Not typical |
| An AI assistant on phone and messaging, in any language | Designed in | Not typical | Partly or sometimes | Partly or sometimes |
| Savings signed off by your own actuary | Designed in | Partly or sometimes | Not typical | Partly or sometimes |
Designed in, or typical of the categoryPartly or sometimesNot typicalQualitative, by category rather than company, from public materials as at October 2026.
Governed by design
Ready for your clinical, security and compliance review.
Insurers stay accountable for the AI they use. Here is what your reviewers will want to see, and documentation is available under NDA.
Work for a health authority? See Averra for public health
- Never used for pricing or cover. Member data is never used to set a price, decide cover or assess a claim.
- Your brand, your members. Co-branded or white-label, with consent captured per data source.
- Clinicians decide. AI arranges and prepares. Licensed clinicians make every clinical and authorisation decision.
- Every decision explainable. Factors, weights and rule version are logged at every change of level.
- Clinical safety. A practising doctor accountable for clinical safety, with a documented safety case signed off before each deployment.
- Data protection. Averra acts as your processor for claims data. A data protection impact assessment is completed before each deployment, and data is hosted where your health-data law requires.
- Security pack, under NDA. Architecture and data-flow diagrams, access and encryption controls, sub-processors, incident response and model validation, ready for your questionnaire.
- Each client kept apart. Every insurer’s claims, rules and reports held separately, with access logged.
- Full audit rights. Your team, or a reviewer you nominate, can audit every calculation and the claim lines behind it.
- Alongside your administrator. Your TPA keeps running claims administration.
Questions
Questions insurers ask us.
How does Averra help insurers lower their loss ratio?
In two ways. Claims intelligence finds over-prescription, unnecessary testing, provider overcharging, unwarranted variation and fraud in your claims, each traced to the claim line. And each member’s digital twin spots deterioration early, confirms it with a home test and routes the member to a doctor while care is still simple.
Can Averra detect fraud before a claim is paid?
Yes. Every claim is checked as it arrives, for cover, pre-approval, coding, tariffs, duplicates and prescriptions without a supporting diagnosis. Paid claims are also reviewed for patterns no single claim reveals, such as unusual provider behaviour against case-mix or services billed but not received. Each flag carries its evidence, so your team can act on it.
What makes Averra different from payment integrity vendors?
Averra does payment integrity before and after payment, and connects it to something claims tools never see: a continuously updated twin of each member that prevents avoidable cost. Both feed one savings statement, signed by your own actuary.
How are savings measured?
On your own claims, by your rules: a risk-adjusted baseline, a matched control group, strict attribution, a run-out aligned to your reserving, and a statement signed by your actuary or a reviewer you nominate before anything is invoiced.
How do we start?
With a retrospective review of your historical claims, under a data processing agreement. No members are involved and nothing is asked of them until much later, and only if you choose.
Is member data used for pricing, underwriting or claim decisions?
No. Member data is never used to set a price, decide cover or assess a claim. You see verified savings, flagged claims, provider variance, risk tiers and aggregated outcomes, not members’ raw health data.
What data do you need to start?
Twelve months or more of paid claims at line level, your benefit tables and policy wordings, provider contracts and tariffs, and pre-approval records, sent by secure transfer under a data processing agreement. Nothing connects to your live systems in phase one.
Does Averra decide pre-approvals on its own?
No. Averra can approve clear requests that meet criteria you have set. Anything needing clinical judgement goes to a licensed clinician with the evidence, and the reason for every outcome is recorded.
Can members choose their own provider?
Yes. Averra suggests the right place in your network and explains why. Members can always choose another provider in your network.
Does Averra replace our third-party administrator?
No. Averra works alongside your administrator and makes its work faster: claims checked as they arrive, fraud, waste and abuse flagged before payment with the evidence attached, and member questions answered by Prime Assist. Administrators can also use Averra directly, across the insurers they serve.
How is Averra paid?
From savings that are realised on your claims and signed off by your actuary. No saving, no fee. Commercial terms are shared in a confidential briefing.
See it on your own claims.
Start with a confidential briefing. We’ll walk through the platform, the measurement protocol and a live demonstration under NDA.