SmartLight Analytics

What SmartLight Analytics does

SmartLight Analytics is a private healthcare analytics company founded in 2016 and headquartered in Plano, Texas, that provides AI-powered claims monitoring and fraud, waste, and abuse (FWA) detection services for large self-funded employers. The company's core platform continuously analyzes 100% of medical, pharmacy, and dental claims data using proprietary inferential analytics models, identifying payment anomalies, duplicate payments, and billing errors that traditional sampling-based audits routinely miss. The platform is augmented by clinical physicians and former federal healthcare fraud investigators who validate AI-flagged anomalies and work with carriers and third-party administrators (TPAs) to recover overpayments and remediate future losses.

The company's product portfolio centers on the Ongoing Claims Monitoring service, supplemented by three additional offerings: SmartLight Health Data Warehouse (SHDW), a data pipeline and stewardship solution; Fiduciary Value Analysis (FVA), an educational tool for ERISA fiduciary compliance; and PBM RFP Consulting, which provides independent pharmacy benefit manager selection and contract evaluation. The company targets large self-funded employers—typically those with 30,000 or more members—with a particular focus on Fortune 500 companies and organizations facing fiduciary responsibility under ERISA and the Consolidated Appropriations Act (CAA).

SmartLight pursues an enterprise field sales go-to-market motion, engaging directly with HR leaders, benefits executives, and CFOs at large self-funded employers. Revenue is generated primarily through subscription/recurring claims monitoring engagements, typically structured on an outcome-based pricing model tied to a percentage of identified savings (3-5% of total health spending), with supplemental professional services revenue from PBM consulting. Named customers include US Foods, 7-Eleven, Dean Foods, Prudential, International Paper, and the City of Fort Worth, with the company reporting an average 4X ROI for clients. The company was recognized on the 2022 Inc. 5000 list (No. 148 nationally) with 400%+ three-year revenue growth.

Name

SmartLight Analytics

Legal name

SmartLight Analytics

Website

https://smartlightanalytics.com

Company type

Private

Founded year

2016

Operating status

Operating

Headcount range

1–10 employees

Short description

SmartLight Analytics is a private healthcare analytics company that uses AI-powered, proprietary inferential analytics to continuously monitor 100% of medical, pharmacy, and dental claims for large self-funded employers (typically 30,000+ members), identifying fraud, waste, and abuse to recover overpayments.

Ownership category

akta.pro rank

Product category

Healthcare Claims Analytics

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Health and Welfare Funds (525120)

akta.pro primary industry

Pharmacy Benefit Analytics, Reporting & Employer Consulting (HLAEAKAK)

akta.pro secondary industry

Quality Measurement, Reporting & Benchmarking (HEDIS/Stars/CQM) (HLACAHAC)

Keywords

• Healthcare claims monitoring
• Fraud waste abuse detection
• Self-funded employer benefits
• Pharmacy benefit consulting
• Claims analytics platform

Headquarters

HQ city

Plano

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Marketing or Sales, Operations

Revenue model

1. Healthcare Claims Monitoring Services: Ongoing monitoring of self-funded employer healthcare claims data to identify and eliminate wasteful spend. SmartLight works behind the scenes with carriers and TPAs to recover overpayments and prevent future losses. Pricing appears based on percentage of savings identified or as a service fee.
2. PBM RFP Consulting: Consulting services for Pharmacy Benefit Manager selection, contract renewals, and performance evaluations. Helps self-funded employers navigate PBM selection with unbiased scrutiny.

Pricing tiers

Go-to-market motion2 records

Distribution channels1 record

Marketing channels5 records

Core offering

SmartLight Analytics provides independent, AI-powered ongoing monitoring of 100% of medical, pharmacy, and dental claims for self-funded employer health plans, using proprietary inferential analytics to detect fraud, waste, abuse, billing errors, and duplicate or pricing errors and to recover overpayments. The offering is supplemented by the SmartLight Health Data Warehouse (SHDW) data pipeline, a Fiduciary Value Analysis (FVA) educational tool, and PBM RFP Consulting services for pharmacy benefit manager selection and contract evaluation.

Product overview

SmartLight Analytics provides a unified healthcare claims cost-reduction platform designed for self-funded employers (typically 30,000+ members). The core product is the Ongoing Claims Monitoring service, which uses AI-powered anomaly detection to analyze 100% of medical, pharmacy, and dental claims continuously. This core platform is supplemented by two additional tools: Fiduciary Value Analysis (FVA), an educational tool for employer fiduciary responsibility, and SmartLight Health Data Warehouse (SHDW), a data pipeline for claims reporting. An optional PBM RFP Consulting service provides independent pharmacy benefit manager selection and contract evaluation support. The company differentiates through its combination of proprietary inferential analytics models, clinical expertise, and licensed private investigators for fraud validation.

Differentiator

Problem solved

Functional benefit

Products and services

• Ongoing Claims Monitoring Continuous, independent AI-powered monitoring of 100% of medical, pharmacy, and dental claims for self-funded employer health plans to identify fraud, waste, abuse, billing errors, duplicate payments, and pricing errors and recover overpayments.
• PBM RFP Consulting Independent Pharmacy Benefit Manager consulting service that guides self-funded employers through PBM selection, contract renewals, market checks, and performance evaluations with unbiased scrutiny.
• Fiduciary Value Analysis (FVA) Educational tool that helps employers ensure their healthcare programs are beneficial, plan dollars are used for the sole benefit of members, fees are reasonable, and provides opportunities to refine Administrative Services Only (ASO) agreements for optimum value.
• SmartLight Health Data Warehouse (SHDW) Data pipeline and stewardship solution that stores and presents claims administration data, helping employers understand relationships between members, providers, claims administration, and health plans through clear reporting and insights.

Quantifiable outcome

• 3-5% of total health spending typically recovered for clients
• +4 more outcomes

Named customers6 records

Segments3 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability3 records

Feature4 records

Partnerships

Three partnerships are on record, tiered core.

• Health Transformation Alliance (HTA)coreStrategic or Co-development Partner · 1 May 2020SmartLight Analytics joined forces with Health Transformation Alliance in May 2020 to reduce healthcare costs for some of America's largest employers. HTA is a cooperative of self-insured employers working to transform healthcare delivery and reduce costs. SmartLight was nominated by HTA for the D CEO Excellence in Healthcare Award.
• City of Fort WorthcoreStrategic or Co-development Partner · 18 July 2019The City of Fort Worth engaged SmartLight to analyze employee healthcare claims data. In 2017, the city's healthcare budget went $15.2 million over budget. SmartLight identified and helped recover $4.9 million in overpayments for the city's health plan covering 6,000+ employees plus dependents.
• Dean FoodscoreStrategic or Co-development Partner · 1 January 2016Dean Foods has worked with SmartLight since 2016 to reduce healthcare costs for their 16,000 employees. Mike Adams, VP of Benefits & HR Systems, noted SmartLight established a good working relationship with their medical claims processor and helped recover costs that were credited back to the company.

Scale indicators6 records

Recent moves13 records

Expansion highlights3 records

Direct peers

• Cotiviti: Payment-integrity and healthcare-analytics vendor serving health plans and large payers with claims-based fraud, waste, and abuse detection — the most direct scaled competitor to SmartLight's core Ongoing Claims Monitoring offering.
• Zelis: Healthcare cost-management platform offering payment integrity, network management, and claims analytics for payers and employers — overlaps directly with SmartLight's value proposition for self-funded employer health plans.
• PillarRx Consulting: Independent PBM consulting firm helping self-funded employers evaluate, select, and negotiate PBM contracts — directly competes with SmartLight's PBM RFP Consulting service line.
• Pareto Intelligence: Healthcare analytics firm providing payment-integrity, risk-adjustment, and quality-measurement services to health plans and providers — comparable in scope and buyer to SmartLight's enterprise analytics offering.
• MultiPlan: Public cost-containment company using data analytics to detect overpayments and reduce claims costs for payers, employers, and TPAs — direct competitor in the payment-integrity space SmartLight occupies.
• SCIO Health Analytics (emids): Healthcare analytics and payment-integrity firm offering claims analytics, FWA detection, and clinical review services — directly comparable services to SmartLight's ongoing claims monitoring and clinical investigation capabilities.
• ClaimDOC: Independent healthcare cost-containment firm focused on claims auditing and reference-based pricing for self-funded employers — directly competes with SmartLight's claims-monitoring and fiduciary-oversight thesis.

Broad incumbents

• Optum (UnitedHealth Group): Diversified health-services arm of UnitedHealth Group with massive in-house payment integrity, analytics, and PBM capabilities — overlaps SmartLight's value proposition but at vastly larger scale and as part of a much broader portfolio.
• Health Catalyst: Healthcare data-and-analytics platform serving health systems and payers with population health and quality measurement — adjacent analytics capability targeting similar enterprise healthcare buyers.

Others

• Health Transformation Alliance (HTA): Cooperative of large self-insured employers and SmartLight's strategic distribution partner; comparable as a channel/ecosystem participant that aggregates the same buyer base SmartLight targets.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xtwitter.com/SLanalytics
• LinkedInlinkedin.com/company/10777631/admin

Revenue estimate

Valuation estimate

Number of profiles

Profiles5 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about SmartLight Analytics