Why are healthcare claims still so full of waste, friction, and missed savings?
In this episode of Broken Healthcare, Ray Kober sits down with Stephen Carrabba, CEO and Co-Founder of Claim Informatics, to break down what’s really going on behind the scenes in healthcare claims, payment integrity, and fiduciary oversight.
Stephen explains how his team helps employers, TPAs, brokers, and captives uncover hidden claims waste through independent review, prepayment, post-payment recovery, and AI-powered contract analysis. We also get into why transparency matters, how conflicts of interest distort the market, and why so many plan sponsors still don’t have a full view of what they’re actually paying for.
If you’re an employer, benefits leader, broker, TPA, or consultant, this episode will make you look at healthcare claims very differently.
Topics covered:
- Why healthcare claims are often paid incorrectly
- How Claim Informatics finds hidden waste
- Why transparency and data access matter
- The role of ERISA, the CAA, and fiduciary duty
- How AI can help — and where it can go wrong
- Why independent oversight is so important
#BrokenHealthcare #HealthcareClaims #ClaimInformatics #StephenCarrabba #HealthInsurance #BenefitsConsulting #PaymentIntegrity #ERISA #HealthcareTransparency #AIinHealthcare #Podcast #EmployerBenefits #HealthcareCosts #FiduciaryDuty
Timestamps:
0:00 Why Healthcare Claims Feel Broken
2:12 How Stephen Got Into the Space
5:10 From Pharma Audits to Claim Informatics
8:20 Why Medical Claims Are More Complex
11:35 The Broker and TPA Problem
14:20 What Changed After the CAA
17:10 Why Data Access Matters
20:20 How Claims Are Audited
23:35 Prepayment vs Post-Payment
27:00 Real Savings at Scale
30:15 How Their Fee Model Works
33:20 Why Shared Savings Creates Conflicts
36:40 Independent Oversight and Fiduciary Risk
40:05 Why Recovery Gets Harder Over Time
43:10 How Much Money Gets Missed
46:20 Why Contracts Matter
49:30 The AI Layer
53:05 What Employers Should Demand
57:00 Final Thoughts
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