Workers' Compensation

Quicker Claims,
Improved Quality of Care.

Dedicated teams of remote clinicians decrease the duration of claims at a fraction of the cost.

Quality-Focused Services to Drive Efficient Clinical Operations

Utilization Review

Experts in the Utilization Review process with millions of cases processed every year

Bill Review

Millions of provider, facility, and reconsideration bills are reviewed annually to ensure the services provided are accurate based on state guidelines

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Nurse Triage

Flexibility in schedules, offering a 24/7 solution for nurse triage coverage, with consistent quality results

Peer Review & Quality Assurance

Peer Review Preparation & Quality Assurance

20% cost reduction in utilizing a clinical team to prep peer review reports for U.S. clinicians

Document Management

We offer indexing, sorting, and bookmarking services for a variety of areas

Network Management

Provider validation and creation of panel cards for all mandatory and non-mandatory states

Customer Service

We provide customer service support to callers regarding medical bill status, PPO reimbursements, fee schedules, and appeals

Claims Support

Customized task-based support models to support our clients’ claims examiners

Pharmacy Reviews

Medication and prior authorization review of medication requests at the point of sale before the pharmacy dispenses the medication

Case Management Support

Support case managers in return to work efforts for injured workers, providing administrative and clinical support functions such as intake, prep, and QA

Poor Quality is Costly. At Shearwater Health, Quality is Our Top Priority.

0 M +

Utilization Review Cases Closed / Year

~ 0 %

Cost Savings

Quality Audits / Year

0 %

Quality Audit Score

0 M +

Cases Handled / Year

We Understand the Current Landscape

Clinical shortages sacrifice quality

Timely access to treatment and support is necessary for positive outcomes.

Industry pressure on claim operations

High caseloads, excess paperwork and delays approving services compromise quality care.

Increasing expense finding qualified talent

Inability to hire or retain talent results in underqualified staff.

Partner with us to Deliver Quality Outcomes at Scale

Our People

Philippines RN and USRN licensure
Talent has full spectrum of skills
Talent spans frontline to leadership roles
500+ dedicated resources supporting UM/UR

Our Process

Proficient in 33+ healthcare IT platforms
Support short-term and long-term client needs
HITRUST and SOC 1 & 2 certified
Continuous improvement embedded with Lean & Six Sigma teams
Enhance Workers Compensation Utilization Management

Our Results

Decreased duration of claims
99.7.% Quality Audit Score
Reduce labor costs by 30 - 60%
Handle 16.5M cases per year

Our Accreditations & Certifications

Health Utilization Management Certification

08/01/2027

Workers' Compensation Utilization Management

04/01/2027

Still Unsure? See Us In Action!

Review our real-life examples of custom solutions we have created workers' compensation organizations just like you.

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