Avelis, Inc.

Avelis Health utilizes advanced machine learning models to enhance payment integrity solutions for self-insured employers and health plans, aiming to significantly reduce healthcare costs through efficient claim auditing and error identification. Founded in 2025 and headquartered in San Francisco, US, Avelis, Inc. specializes in payment integrity solutions. The company secured USD 500,000 in Seed funding from Y Combinator on June 25, 2025.

Avelis has completed one deal to date, focusing on optimizing health plan expenditures. Avelis Health offers a suite of payment integrity solutions aimed at self-insured employers and health plans, focusing on reducing health plan expenditures by 3-7% annually. Their primary service involves seamless claim auditing, which integrates with third-party administrators (TPAs) to conduct post-payment audits on 100% of claims, ensuring that nuanced billing errors are identified without disrupting member benefits. The company employs advanced machine learning models to uncover hidden savings from billing discrepancies, providing detailed documentation and audit trails for every claim adjustment.

Avelis also extends its capabilities to manage provider appeals, acting as an auxiliary resource for appeals teams in handling provider disputes. The clientele includes self-funded plan sponsors and health plans across the United States, targeting various geographical markets where there is a significant presence of self-insured employers. Avelis Health's revenue model is structured around partnerships with self-insured employers and health plans, focusing on B2B transactions. Through their services, the company generates income by providing value-added solutions that guarantee savings on health plan expenditures.

Clients engage Avelis to perform comprehensive audits and claim adjustments, effectively creating a transaction framework based on performance guarantees. The service agreements often include provisions that outline the scope of payment integrity audits, with a focus on recovering overpayments and identifying billing errors. Specific pricing plans for their services are established through negotiations with clients, reflecting the customized nature of their offerings, which are designed to fit the unique needs of each employer or health plan. Avelis Health intends to leverage the recent Seed funding of USD 500,000 to expand its technological capabilities and enhance its machine learning models.

The company is exploring the development of new products that will streamline their service offerings and improve auditing processes. Additionally, Avelis plans to target new geographic regions for market expansion, focusing on areas with a high concentration of self-insured employers across the United States. These initiatives are part of a broader strategy to establish a significant presence in the healthcare payment integrity market.