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

• Disconnected systems for member history, outreach, and provider/pharmacy coordination
• Manual steps across tools, slowing follow-ups and making outreach inconsistent
• RCM denials and coding errors carrying direct revenue cost; billables leakage grew with volume
• Growth and cost locked together: the economics the client wanted to break

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.

What Changed in the Work

• Manual, per-member → Outreach runs itself
• Chasing systems → One member record
• Coding by hand → Agents prepare, humans judge
• More staff per member → More reach, same team

What We Delivered

• HIPAA-Ready Care Operations Platform
• AI-Ready Data Foundation
• Automated RCM Workflows with Agentic AI
• OKR and Strategy Execution System

Care scales. Headcount doesn’t. 

KEY RESULTS DELIVERED

Capabilities Applied 

• HIPAA-Ready Platform Engineering
• Agentic AI for Care Operations
• RCM Workflow Automation
• AI-Ready Data Foundation