You don’t have to do it alone.

Whether you’re a national carrier, regional health plan, or third-party administrator, you’re under pressure to deliver more — better outcomes, faster decisions, lower costs — all while navigating increasing complexity. The problem isn’t vision. It’s bandwidth.

That’s where we come in.

We partner with payer organizations to operationalize the work that matters — from core services to bold new initiatives — with scalable, cost-effective clinical talent. Whether you’re looking to sustain existing operations, extend your capabilities, or test new programs, we make it possible.

With a team of 1,000 + clinicians and a model that blends your onshore with our offshore expertise, we deliver high-quality support that integrates seamlessly with your teams. Every solution is thoughtfully built, long-term, and designed to evolve with you — helping you reduce spend without reducing impact.

Talent without Borders, Solutions without Limits.

80% of our workforce is clinical — which means every solution is built with a deep understanding of the healthcare ecosystem. Whether you need help streamlining your operations, meeting (or expanding) capabilities, or managing costs, our flexible, clinician-led model meets you where you are. We work as your strategic partner through customizable solutions that enable you to achieve your priorities and goals in the most cost-effective manner.

Flip Grid

Utilization Management & Clinical Decisioning

Eligibility & Benefits Verification
Multi-Channel Intake & Case Set-Up
Clinical Summarization & Case Prep
Clinical Reviews & Determinations
Post Service and Post Claims Clinical Reviews & Determinations
Appeals & Grievances
Network Coordination & Program Audit Support
Gold Card Auditing

Care, Disease, Population Health, and Wellness Management

Initial Outreach & Member Outreach & Member Engagement
Member Program Enrollment
Facilitating Completion of Health Risk Assessments/ Other Assessments
Defining Individualized Care Plans
Health Education & Coaching
Medication Review & Adherence
Care Management/ Care Plan Goal Achievement
Remote Patient Monitoring
Care Coordination and Scheduling of Services

Medical Coding & Risk Adjustment

Medical Record Retrieval
Medical Record Chart Tagging
First and Second Pass Risk Adjustment Coding
Over-Reads ad Quality Audits
RADV Support

HEDIS and Supplemental Coding & Quality Improvement

Medical Record Retrieval
Medical Record Chart Tagging
HEDIS and Supplemental Data Abstraction & Coding
Gap Closures – both data and care gaps
Star Rating(s) Optimization

Ready to turn “what if” into “what is”?

Our experts are ready to provide a tailored consultation, crafting the perfect solution to tackle your biggest challenges.

“The Shearwater team is extremely customer centric. They are willing to put in the extra work meet the current needs. They are dedicated to overall success of programs and the health of the partnership. They are great partners!”

– Payer Client Partner

"Shearwater’s quality in the RA coding space is so consistently high, they’ve singlehandedly raised the bar for the entire market."

– Payer Client Partner

At Shearwater, we understand that confidentiality is key. Many of our clients prefer to keep their partnerships private, and we respect that. The above insights have been carefully curated to share the positive impact we’ve made while ensuring complete anonymity.

Your Payer Team

Partnering with us means gaining a hand-selected team committed to your success. From day one, you’ll be supported by dedicated supervisors, quality and training experts, and a U.S.-based account manager who acts as your direct line to your offshore team. We don’t believe in one-size-fits-all — we build around you, ensuring a seamless, high-touch experience every step of the way.

Susan Wintersheimer

SVP, Payer Solutions

“At Shearwater Health, there’s nothing more rewarding than helping our payer partners achieve exceptional results. Whether it’s through innovative solutions, strategic insights, or seamless execution, my team consistently delivers outstanding outcomes. Leading such a diverse and talented group is what makes this work so rewarding.”

You don’t have to do it alone.

That’s where we come in.

Talent without Borders, Solutions without Limits.

Ready to turn “what if” into “what is”?

Your Payer Team

Susan Wintersheimer

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