The most demanding seat in managed care
Specialty benefit managers — dental, vision, hearing, therapy, transportation, and other delegated administrators — take delegated functions from health plans and inherit their exposure:
And every year, their delegation oversight audits get tougher.
You inherit the plan’s compliance exposure. Do you have the plan’s technology to carry it?
Enterprise capability at SBM economics
CareInsight automates the exact functions plans delegate to you — utilization management, appeals and grievances, claims resolution, member notification — with the audit trail that makes delegation oversight reviews a non-event.
Where it helps
Requests auto-classified, evidence retrieved automatically, criteria applied consistently, decisions routed within the delegating plan’s timelines — with turnaround you can report to every client from one system.
The Intake Agent converts any channel to a classified case in 2 minutes and flags expedited requests immediately. Evidence assembly, decision recommendation, and notification run end to end, timestamped for the delegation file.
The Claims Pend Resolution agent cuts pend resolution from 25–30 minutes to under 5, letting you absorb new contracts and volume without proportional hiring.
Walking into an RFP with AI-driven turnaround, complete audit trails, and per-case economics no manual competitor can match changes the conversation.
Why delegated entities choose CareInsight
Your model is doing the plan’s work better and cheaper than the plan can. CareInsight cuts the cost of delegated functions 40–60% while strengthening the compliance documentation your contracts depend on — margin that protects your book and wins the next one.