Enrollment is growing.
Your visibility into where
operational cost compounds isn’t.
Bramble maps payer operations to reveal where claims adjudication capacity is lost, where prior authorization friction creates provider abrasion, and where care management workloads compound — then drives sustained improvement across every line of business.
Payer operations face compounding volume — with declining operational visibility
Enrollment grows. Regulatory requirements expand. But the tools meant to provide clarity still describe throughput and denial rates, not the operational friction that drives cost per member upward and degrades provider relationships.
Medicare Advantage enrollment
MA enrollment continues to surge, driving claims volume, prior auth requests, and care management caseloads upward without proportional operations staffing.
Prior auth rework rate
Authorization requests that require re-review, additional clinical documentation, or peer-to-peer escalation — each cycle consuming medical reviewer capacity.
Systems per member interaction
Claims platforms, UM systems, care management tools, provider portals, and member CRM operate in silos with no unified view of operational capacity.
Typical reviewer utilization
The remaining 37–45% isn't idle time — it's friction. Incomplete submissions, system navigation, re-reviews, and process ambiguity across authorization and claims.
Your reporting tracks throughput. Not why authorization cycles keep extending.
Traditional reporting tracks claims processed, authorization turnaround times, and denial rates. But it doesn't reveal where medical review capacity is wasted, why prior authorizations create provider friction, or what causes delays in care management workflows.
“We could tell you our prior auth turnaround to the hour. We could not tell you why it was trending upward, which step was the bottleneck, or what our medical reviewers were spending their time on.”
— VP Clinical Operations, Regional Health PlanBuilt for the workflows that define payer operations
Bramble maps operational performance across claims, utilization management, care coordination, and member services — revealing friction that traditional reporting treats as a black box.
Claims Adjudication
Map the end-to-end claims processing workflow across product lines. Identify where examiner capacity is consumed by pended claims, coding disputes, and manual overrides.
Prior Authorization
Baseline the authorization lifecycle from submission to determination. Surface where incomplete submissions, clinical criteria gaps, and peer-to-peer escalations extend turnaround.
Medical Review & UM
Quantify medical reviewer and nurse reviewer utilization across concurrent, retrospective, and prospective review. Identify where clinical capacity is consumed by non-clinical administrative work.
Care Management
Map care manager caseloads, outreach patterns, and coordination workflows. Surface where caseload inequities, documentation burden, and follow-up gaps reduce member engagement.
Member Services
Baseline inquiry volumes, handle times, and resolution rates across channels. Identify which inquiry types consume disproportionate capacity and where first-call resolution breaks down.
Provider Relations
Quantify the operational drivers of provider abrasion: authorization delays, claims processing friction, credentialing backlogs, and dispute resolution cycles that erode network relationships.
From baseline to sustained improvement in 90 days
Bramble connects to your claims, UM, care management, and member services systems to build a trusted operational baseline — then reveals where capacity is being lost and establishes the rhythm to recover it.
Establish Baseline
Bramble connects to claims platforms, UM systems, care management tools, and workforce data to build a trusted operational baseline — no process mapping required.
Reveal Operational Friction
Surface the hidden authorization bottlenecks, capacity imbalances, and rework patterns that inflate cost per member and degrade provider experience.
Enable Sustained Improvement
Targeted interventions launch in priority order. Authorization turnaround, reviewer utilization, and cost per member improvements are measured continuously against Star Ratings impact.
Operational performance directly impacts Star Ratings measures
Claims processing speed, authorization turnaround, member services responsiveness, and care management engagement all feed CMS Star Ratings. Bramble connects operational improvement to the measures that determine plan competitiveness.
Modeled from cross-industry deployment data and payer operations benchmarks
Based on measured results across enterprise operations deployments and payer-specific operational benchmarks. Specific payer case study metrics will replace these projections.
Projections based on cross-industry deployment data. We’ll validate these benchmarks with your specific operational data during the ROI assessment.
See where your health plan operations are losing capacity
We'll map your claims, authorization, and care management workflows, identify friction points, and show you the operational improvement path — with payer-specific benchmarks.
For COOs, VP Clinical Operations, and Health Plan Operations Leaders