HMOs
Claims operations
Move claims, benefit checks and provider questions through one clear operating rhythm.
Platform
One platform for the entire claims lifecycle
Claims adjudication, AI fraud intelligence, provider settlements, eligibility and analytics - composable modules on a single system of record.
Healthcare teams we currently serve
Showing Claims operations
Vetra AI + operations
Vetra AI watches every handoff in the insurance operation.
A hospital visit touches eligibility, approvals, claims, fraud checks, payments and reporting. Vetra keeps every handoff in one operating record, with AI risk signals visible before money moves.
Vetra AI
AI risk signals sit beside the real operational record.
Vetra AI does not hide in a separate report. It appears where teams approve care, review claims, resolve anomalies and prepare provider payments.
Duplicate detection
Finds repeated claims, copied codes and suspicious recurrence.
Tariff intelligence
Compares bills against plan rules, benefit limits and provider history.
Next-action guidance
Shows reviewers what to approve, reject, escalate or request.
Vetra AI flagged a duplicate risk
96% confidence · same enrollee, provider and procedure pattern found.
Six operating lanes
One claim, six connected systems.
Each lane has a clear job. Vetra AI connects the signals between them.
01
Vetra Eligibility
Confirm who is covered before care starts.
Member, plan, limits and dependants are checked at the front desk.
JOActive
John Okafor
HYG-DNG-00234-PR
02
Vetra Authorizations
Turn pre-approval into a rules-led workflow.
Urgency, tariff bands and approval limits guide the decision path.
Authorization
Coronary Angiography
AUT-5512Approved
03
Vetra Claims
Adjudicate every provider bill with context.
Clinical notes, plan rules and provider history sit beside the claim.
St. NicholasIn review
ReddingtonApproved
04
Vetra AI Intelligence
Catch leakage before money moves.
Vetra AI flags duplicates, abnormal volume, tariff breaches and suspicious provider patterns early.
Duplicate suspected
96% confidence · CLM-24812
05
Vetra Settlements
Pay providers from a reconciled ledger.
Approved claims become settlement runs with receipts and audit trails.
Net payable
₦171.2M
38 claims · reconciled
06
Vetra Analytics
See the operation clearly while it is happening.
Leadership tracks loss ratio, turnaround, leakage and provider pressure.
Loss ratio · trending down
Vetra speed
The work is still rigorous. The handoffs are faster.
Every workflow has a clear first action, a rules-driven middle and a decision the next team can trust, with Vetra AI checking risk between handoffs.
Clean care approvalsAuthorizations
Pre-authorizations become a rules-led care decision, not a phone chase.
Minute 1
Hospital requests approval
Minutes later
Policy rules and reviewer limits applied
Same day
Authorization code returned to provider
Vetra Intelligence
AI that catches fraud before you pay for it
Every claim is scored the instant it arrives - surfacing duplicates, tariff breaches and anomalies with explainable confidence, so your team reviews what matters and approves the rest with certainty.
- Duplicate & double billing
- Tariff-breach & upcoding
- Utilization anomalies
- Eligibility & lapse risk
₦0.0B+
Exposure flagged
0%
Detection precision
0.0s
Avg. scan time
0%
Leakage reduced
“Duplicate claim suspected - CLM-24812 billed twice in 48h.”
Settlement engine
Pay every provider, accurately and on time
Turn approved claims into reconciled payouts without leaving the platform - with the controls finance teams need and the speed providers love.
- Batch approved claims into settlement runs in one click
- Multi-level approval matrix that scales with payout size
- Pay over NIP and bank transfer, then auto-reconcile
- Provider-facing remittances and dispute resolution
Settlement run · May
STL-2026-041
Net payable
₦171,200,000
38 claims · gross ₦184.5M · 7.2% adjustments
St. Nicholas Hospital₦27.3M
Reddington Hospital₦18.9M
Lagoon Hospitals₦64.2M
Reconciled against bank statement · 0 discrepancies
Loss ratio & utilization
Live0.72
Gold Family
0.58
Silver
0.91
Platinum
Analytics & reporting
Operational truth, in real time
Loss ratios, utilization, settlement latency and fraud exposure - surfaced as living dashboards and exportable reports your board will actually trust.
0.0%
Approval rate
across the network
0.0 days
Avg. settlement time
down 18% QoQ
0K
Lives covered
on Vetra today
₦0.0M
Claims / month
processed at peak
Security & compliance
Built for the most regulated industry there is
Healthcare data demands more. Vetra is engineered with defense-in-depth, least-privilege access and a complete audit trail by default.
SOC 2-aligned
Controls modelled on SOC 2 Type II across security, availability and confidentiality.
Encryption everywhere
Data encrypted in transit (TLS 1.2+) and at rest (AES-256), with isolated tenant data.
Granular RBAC
Role templates, per-user approval limits and data-scope boundaries enforced server-side.
Immutable audit logs
Every permission-sensitive action recorded, append-only, and exportable.
MFA & SSO
Multi-factor authentication and enterprise SSO for every workspace.
Data residency
Regional hosting options and tenant isolation for compliance-sensitive deployments.
Complies with the highest standards of quality and data security
Please Note: Your data is confidential and secured by HIPAA, GDPR, and NDPR standards.
Trusted By
Run your insurance operation on infrastructure built for it
See how Vetra unifies claims, fraud intelligence and settlements - book a walkthrough with our team.