Скачать или смотреть AI-Powered Claims: The Innovation Changing Healthcare Ops | Episode 49

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You can also apply to be the guest on TeqTalk: https://www.teqfocus.com/teqtalks/


You can connect with:
Jas Kaur, CTO, Teqfocus:   / jas-kaur-5396b237  

Falko Buttler, Chief Technology Officer, Lantern:   / falkobuttler  

Paul Risk, VP of Technology Consulting, Teqfocus:   / paulrisk  

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Behind the complexity of medical billing and claims adjudication lies an enormous opportunity to rebuild healthcare payments with data, automation, and AI.

In this episode of TeqTalk, Jas Kaur sits down with Falko Buttler (CTO, Lantern) and Paul Risk (VP, Financial Services, Teqfocus) to break down the future of healthcare claims management from faster adjudication and pricing accuracy to transparent reimbursements and modern TPA workflows.


We explore how next-generation TPAs like Lantern are transforming the claims lifecycle by:
Why U.S. healthcare still struggles with data silos and inconsistent pricing
Reducing claim processing times from 120+ days to just 5.8 days
Using AI, OCR, and automation to streamline claim intake, coding, and pricing
Tackling coding errors, fragmented data, PDFs, barcodes, and manual workflows
Enhancing provider experience with predictable and transparent reimbursements
Reducing claim denials through better eligibility, network checks, and clean data
Modernizing the TPA model with outcome-driven, efficiency-focused processes
Why many TPAs are adopting AI-enabled claims adjudication and automated pricing
What a realistic 12-month claims modernization roadmap looks like for payers, TPAs, and employers


Timestamps:
00:00 – 00:55 - The $19B Claims Problem & Why AI Matters
00:55 – 02:30 - Guest Introductions
02:30 – 05:15 - What Makes Modern TPAs Different?
05:15 – 07:45 - How the Payer Ecosystem Has Changed
07:45 – 10:20 - Where Claims Slow Down (Transparency, Data, Speed)
10:20 – 12:40 - Why Claim Processing Takes 60–120 Days
12:40 – 14:15 - How Lantern Achieves 5.8-Day Claim Processing
14:15 – 17:00 - Real Patient Story: The Human Cost of Denials
17:00 – 20:00 - The Root Cause: Fragmented, Non-Relational Systems
20:00 – 23:00 - Why Healthcare Needs Standardized Frameworks
23:00 – 26:00 - Price Transparency: Global Comparisons (US vs Germany)
26:00 – 29:00 - How do Hospitals Still Use Legacy Processes (ICD, COBOL, etc.)
29:00 – 31:00 - Unexpected Hospital Bills & Negotiation Realities
31:00 – 34:00 - The Pain of Manual Billing & Delayed Claims
34:00 – 37:00 - Unstructured Data: PDFs, Barcodes & Missing Context
37:00 – 40:00 - How AI + OCR Improve Accuracy in Claim Intake
40:00 – 42:00 - AI’s Value: No Fatigue, No Bias, Consistency
42:00 – 44:00 - Why Good Data Matters More Than Good AI
44:00 – 47:00 - Understanding Claim Denials (Common Causes)
47:00 – 49:00 - Reducing Denials with Identity, Network & Contract Alignment
49:00 – 51:00 - Pricing Models for TPAs: PMPM, Shared Savings & Case Rates
51:00 – 53:20 - The 12-Month Claims Modernization Roadmap
53:20 - The Future: Real-Time Claims & Connected Data

If you're involved in healthcare claims, insurance operations, adjudication, TPAs, rev cycle, employer benefits, or health tech, this episode provides an inside look at what’s coming next.

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About podcast:

TeqTalk is a leading technology podcast hosted by Jas Kaur, focused on the future of AI, data, and digital innovation, especially in healthcare, pharma, and tech space. Each episode features exclusive conversations with CXOs, CIOs, data architects, and industry experts from across the US and Canada.

From AI-powered transformation and natural language data access to real-time insights and data integration, TeqTalk explores how modern businesses can bridge the gap between technology and strategy. Whether you're a tech leader, marketer, or innovation enthusiast, TeqTalk delivers practical knowledge, thought leadership, and cutting-edge trends shaping the future of enterprise solutions.

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