A multi-year engagement transforming fragmented PBM operations into a unified, HIPAA-compliant digital foundation.
One of the fastest-growing US pharmacy benefits managers, built on a promise of transparent, member-first benefits, where growth had made care management the constraint on scale. The organization serves members, employer clients, TPAs, and care teams across a fully integrated prescription care model, operating at the intersection of clinical operations and pharmacy benefits management. With a mandate to scale without complexity, the business needed its technology to grow as ambitiously as its membership.
Technology needed to scale as fast as membership did.
Scaling care meant scaling headcount
The customer needed enterprise-grade care operations performance while simultaneously building a unified member experience and delivering real-time RCM accuracy. Meeting all three at once demanded deep PBM domain expertise, platform engineering, and a way to accelerate innovation without proportionally growing the engineering team.
Pain Points
Better care. Greater scale. Without growing headcount.
Built on the workflow, not the org chart.
Veltris designed a HIPAA-compliant care operations platform with a single AI-ready data foundation. Automated workflows manage outreach and coordination, while autonomous agents support claims and coding with human review on exceptions.
From executing steps to supervising outcomes.
Step Flow
What Changed in the Work
What We Delivered
Care scales. Headcount doesn’t.
KEY RESULTS DELIVERED
member portal adoption
fewer costly claim denials
proportional headcount added
AI-ready data foundation
reduction in revenue leakage
efficiency gains
Capabilities Applied
Improving member experience while tightening efficiencies are both critical. Veltris helps us focus on decisions that meaningfully improve how we serve members and operate as a differentiated PBM. They bring the right pace, mindset, and ownership to deliver outcomes.
