Payer Performance Studio
Reducing Medical Spend.
Reducing Administrative Cost.
Our Solutions
Smarter Tools to Reduce Spend and Strengthen Accuracy
The HealthWorks Payer Performance Studio delivers a suite of services designed to build accuracy into the payment process, reduce waste, and minimize friction with providers. Each offering is backed by operational leaders with deep payer, provider, and CMS experience.
Contract Compliance Intelligence
(Powered by Sleuth®)
Predictive Insights to Strengthen Accuracy and Prevent Mispayments
Ensure payments are accurate before they are made—by applying contract intelligence at the point of decision.
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Identify and correct contract misalignment before payment—eliminating avoidable overpayments.
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Strengthen payment integrity without adding downstream audit and recovery burden.
Motor Vehicle Accident Monitoring
Identify Third-Party Liability Claims That Aren’t Yours to Pay
Continuous monitoring of member data to flag potential third-party liability, with automated triggers and expert recovery that convert missed opportunities into recovered dollars.
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Leverage extensive, proprietary, defensible data to accurately identify the responsible party.
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Avoid mispayments and reduce financial leakage with real-time monitoring and expert validation.
Out-of-Network Collections
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Recover Overpayments While Preserving Provider Trust
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Leverage extensive, proprietary, defensible data to accurately identify the responsible party.
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Avoid mispayments and reduce financial leakage with real-time monitoring and expert validation.
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Compliant, provider-sensitive outreach minimizes abrasion.
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Full-service tracking and management accelerate resolution.
Medical Records Review
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Ensure Fair, Defensible Payments With Clinical-Level Validation
Clinical-level reviews of inpatient claims ensure DRG assignments are accurate, defensible, and compliant—strengthening audit readiness and supporting fair payment.
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Prevent costly inaccuracies with expert DRG and coding reviews.
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Strengthen audit readiness and reduce compliance exposure.
The Benefits
The Measurable Impact of Process Integrity
At HealthWorks, we measure success by the impact it has on your bottom line and the strength of your provider relationships.
Our Payer Performance Studio is designed to reduce unnecessary spend, lower administrative burden, and build accuracy into the process—so you can focus on strategy, not rework.
By combining advanced analytics, proprietary data, and decades of operational experience, we help payers pay the right claim, the first time. The result is not only financial savings, but also a stronger foundation of trust with providers and members alike.
Reducing Spend, Lowering Costs, Strengthening Trust
Partnering with HealthWorks delivers measurable benefits that directly impact spend, compliance, and operational efficiency.
- Reduced Medical Spend through accurate claims, fair DRG validation, and subrogation recoveries.
- Lower Administrative Operating Costs by automating reconciliations, reducing manual reviews, and minimizing disputes.
- Improved Compliance & Audit Readiness with defensible, documented processes.
- Stronger Provider Relationships by reducing abrasion and enabling clear, consistent communication.
- Operational Efficiency from actionable intelligence and seamless integration into existing technology stacks.
Our Senior Leadership Team
Led by the Pioneers of Modern Payment Integrity
HealthWorks is led by seasoned operators who helped pioneer modern payment integrity—bringing proven expertise from payers, providers, and CMS.
Darby Brown
A nationally recognized leader in healthcare payment innovation, Darby has built and scaled some of the industry’s most respected payment integrity programs.
Harold Davis
President
With more than three decades at Humana, Harold directed cost containment operations spanning FWA, subrogation, and code edits—leading a program recognized as world-class.
Chad Heflin
Executive Vice President
Chad leads strategic payer initiatives, with deep expertise in subrogation, coordination of benefits, and recovery services that reduce costs while preserving provider trust.
Michael McGauley
With 25+ years in payer operations and payment integrity, Michael co-founded Forensic Claims Solutions and built audit and recovery programs that improved compliance, reduced spend, and delivered results for health plans.
Craig Mills
EVP | Data Mining Technology
With 20+ years in healthcare tech, Craig co-founded Forensic Claims Solutions and developed the Sleuth© platform and algorithms that give payers predictive insights to strengthen accuracy and prevent mispayments.
Let’s Improve Payment Precision—Together.
Partner with HealthWorks to reduce medical spend, strengthen compliance, and protect relationships—without adding complexity.