Stop Pretending Manual Payer Ops Work
Risk isn’t abstract. Payers lose billions to fraud, noncompliance, and wasted operations. Penguin Ai de-risks adoption with governance, privacy, and auditability built in, while cutting costs and delivering ROI in 90 days or less.
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The Cost of Doing Nothing
Every day of business as usual causes revenue bleed and piles on more risk. Penguin Ai is the healthcare-native platform that stops the leakage, de-risks your operations, and delivers measurable ROI in 90 days.
1
Compliance Pressure is Rising
From CMS-0057-F on prior auth to stricter audit requirements.
2
Manual Workflows Create Risk
from coding errors to inconsistent adjudication
3
Fraud, waste, and abuse
Account for 10–20% of all healthcare spend, with billions lost to scams each year
4
The result
higher costs, regulatory exposure, and frustrated providers and members.
For Payers, This is Only the Beginning
Choose the pain point slowing you down — Penguin Ai has a Digital Worker ready to fix it. These are just a few examples in a sea of possibilities.
Prior Authorizations
Slash turnaround times, improve decision accuracy, and stay CMS-0057-F compliant with built-in auditability
Risk Adjustments & Reporting
Identify HCC codes with AI-driven precision, optimize risk scores, and safeguard compliance.
Claims Adjudication
Apply payer-specific rules automatically, reduce rework, and ensure consistent, explainable outcomes.
Payment Integrity
Detect and prevent fraud, waste, and abuse with anomaly detection and risk scoring — closing the gaps that cost you billions.
Why Payers Choose Penguin Ai
De-Risked by Design
Governance, privacy, and auditability built in from day one.
Low Barriers to Entry — and Exit
No lock-in, no wasted investment.
Compliance First
CMS-ready, HIPAA-aligned, and regulator-proof.
ROI Guaranteed
Measurable outcomes in 90 days, or it’s free.
Scalable Platform
Start with one workflow, expand to an AI workforce.
Reduce Risk and Recover Revenue
See how Penguin Ai transforms payer operations — from prior auth to payment integrity.
