SmartLight Analytics

SmartLight Analytics, founded in 2016, monitors employee healthcare claims data on behalf of self-funded employers. The firm's stated purpose is to detect and remove fraud, waste and abuse in health plan spending, and thereby reduce the cost employers bear. Its service is independent of the insurers and administrators that process the claims it reviews, and it examines 100% of medical claims rather than sampling them.

The analytical work pairs proprietary inferential analytics, tailored to each employer's population, with review by clinical staff. Among the patterns the company says it looks for are providers exploiting low-income participants, rehabilitation networks targeting substance abuse patients and improper over-treatment. The stated intent is to recover spending without altering employee behaviour or interrupting benefits. Relevant areas of work include artificial intelligence, healthcare data analysis, fraud detection, clinical data review and data science.

The company was co-founded by Asha George, who has 23 years of experience in healthcare data analysis, and Dr. Franklin Baumann, a former medical director at United Healthcare and chief medical officer of Emdeon. Its team is drawn from healthcare, data science, fraud investigation and insurance. SmartLight Analytics ranked No. 148 on the Inc. 5000 list in 2022, and No. 16 among software companies on that list.