A large health insurer took back control of an underperforming, third-party AI prior-authorization model, and Trexin built the strategy and roadmap behind $6.25M in annual savings.
Our Client, a large health insurer, couldn’t get real-time feedback on prior-authorization requests. They had engaged a third-party vendor to build an AI-guided intake model, but the vendor underperformed and the solution was expensive. They turned to Trexin.
We interviewed stakeholders to diagnose and categorize the prior-authorization challenges, then framed three phases, guided intake, intelligent review, and enhanced clinical review, with guided intake as the focus. Rather than stay dependent on the vendor, we advised the Client to rebuild the AI model internally, with AI experts, so they could reassume control of the product, use their direct provider relationships to gather feedback, and keep improving it, including tighter integration into the provider portal. We delivered guided-intake business requirements, a divestment strategy from the third-party vendor, an investment roadmap with synergy identification, and a five-year model of prior-authorization impact.
We brought the AI engineering judgment and execution discipline to put the Client back in control of their own product, not into another dependency.
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