# ClaimDOC > Smarter claims auditing and member advocacy for self\-funded employer health plans\. ## At a glance | Field | Value | | --- | --- | | Category | Claims Technology | | Type | Solutions Provider | | Region | NA | | Headquarters | West Des Moines, Iowa, USA | | Founded | 2013 | | Stage | Growth | | Employees | 51-200 | | Funding | Bootstrapped | ## Overview ClaimDOC is a national medical claims auditing and member advocacy company serving self-funded employer health plans. Founded in 2013 in West Des Moines, Iowa, the company was created to give plan sponsors a cost-effective and sustainable alternative to traditional insurance carriers and provider networks. ClaimDOC combines licensed healthcare professionals with proprietary technology to audit and negotiate medical claims using objective, nationally-benchmarked reimbursement data. The company's flagship DirectAccess+ platform provides a comprehensive self-funded plan management solution that integrates claims administration, transparent pricing, and member advocacy into a single system. Plans using ClaimDOC report average savings of 25% to 35% compared to traditional plan structures, while members benefit from richer plan designs and lower premiums. ClaimDOC serves a multi-sided market of employers, health plan members, healthcare providers, insurance brokers, and stop-loss carriers -- all interconnected through its reference-based pricing and advocacy infrastructure. ## Products & services ### DirectAccess\+ ClaimDOC's flagship self-funded health plan management platform integrating claims administration, transparent claim pricing, member communications, and real-time reporting in a single environment. Enables employers to replace traditional carrier networks with an objective, benchmarked reimbursement model. **Key features:** - Claims administration and adjudication - Nationally\-benchmarked reimbursement pricing - Member portal and benefit access tools - Real\-time reporting and plan performance analytics - Stop\-loss carrier coordination *Target users:* Self\-funded employer plan sponsors and their TPAs ### Medical Claims Auditing and Negotiation Licensed healthcare professionals review and audit medical claims using objective, nationally-benchmarked reimbursement standards. The service negotiates fair payment rates on behalf of self-funded employers, reducing inflated provider billing. **Key features:** - Line\-by\-line claim review by licensed healthcare professionals - Nationally\-benchmarked reimbursement standards - Direct provider negotiation and settlement *Target users:* Self\-funded employer plan sponsors ### 360 View of Risk A risk assessment platform analyzing health plan cost drivers and performance from the perspectives of the member, employer, and stop-loss carrier. Provides comprehensive visibility into plan risk and cost trends. **Key features:** - Multi\-perspective risk analysis - Cost trend identification - Stop\-loss coordination support *Target users:* Employers, TPAs, Stop\-Loss Carriers ### Member Advocacy Dedicated member advocacy services ensuring plan participants receive fair treatment, transparent pricing information, and effective navigation of the healthcare system. **Key features:** - Member support and issue resolution - Benefit navigation assistance - Provider billing dispute advocacy *Target users:* Health plan members ## Category & focus - Subcategories: Medical claims auditing, reference\-based pricing, member advocacy, self\-funded plan management - Insurance verticals: Health, Group Benefits - Target customers: Employers, TPAs, Brokers, Carriers ## Notable customers - Self\-funded employer plan sponsors \(primary\) - Insurance brokers and consultants distributing ClaimDOC solutions - Stop\-loss reinsurance carriers coordinating on large claims ## Links - Website: - Directory profile: - Linkedin: - Who we are: - Member portal: --- *Last updated: 2026\-04\-09*