How Optum Is Using Real-Time Intelligence to Eliminate Avoidable Claim Denials

Real-time transparency between payers and providers is becoming one of the most transformative levers in the healthcare industry.

In this episode, Optum discusses how their team is tackling the long-standing inefficiencies buried in today’s claims processes. They explain how Optum Real connects payers and providers through a real-time multi-party hub, uses AI to interpret contracts and encounter data, and equips providers with AI-first workflows that dramatically reduce denials, rework, and confusion for patients. They also highlight early pilot results with Allina Health, demonstrating improvements in both patient experience and operational accuracy. She shares why 84% of first-time denied claims are avoidable, why eliminating that friction is at the core of Optum’s mission, and why value-based care will benefit enormously from real-time intelligence. Looking ahead, Optum outlines a bold vision in which real-time payment flows, AI-enabled clinical insights, and improved data exchange reshape the entire system's operations.

Tune in and learn how real-time transformation could redefine healthcare’s future!

Things You’ll Learn:

• Real-time data exchange between payers and providers can significantly reduce the confusion, delays, and costs associated with today’s claims processes. AI-enabled reasoning over contracts and encounters improves accuracy from the start.

• Optum Real aims to bridge the transparency gap by connecting stakeholders through a multi-party hub, enabling real-time understanding of coverage and reimbursement. Early pilots show tangible reductions in denials and improved patient clarity.

• The majority of first-time denied claims are avoidable, signaling an industry-wide opportunity to remove unnecessary rework. Solving this problem increases efficiency for providers, payers, and patients.

• Real-time intelligence opens the door for more effective value-based care arrangements. When providers can see financial implications instantly, incentives align more naturally.

• The long-term vision includes real-time payment flows, AI-driven clinical decision support, and improved patient engagement. Breaking down paper-based silos will unlock entirely new use cases at scale.

Resources:

• Connect with and follow Madhu Pawar on LinkedIn.

• Follow Optum on LinkedIn and visit their website!