Camber's Approach to Billing: AI-Driven Automation with Human Oversight
How Camber's automated platform and Insurance Operations team work together to handle the full lifecycle of a claim, from submission through resolution.
7 min read
Automation and Human Judgment, Working Together
Camber's service model is built around an automated platform that handles the full lifecycle of a claim from submission through resolution without requiring human intervention in the vast majority of cases. Alongside that platform is a dedicated Insurance Operations (InsOps) team: specialists who review what the machine escalates, approve actions on complex cases, and resolve the situations that fall outside what the models can handle on their own.
How the Platform Handles Claims
Camber's platform is built around machine learning models that reverse-engineer the adjudication logic of every payer in a clinic's mix. Rather than submitting claims as they come out of a practice management system, the platform pulls the full underlying data model, rebuilds each claim from the ground up, and checks it against payer-specific predictive models before submission. Claims the models identify as likely to be denied are flagged, along with the reason, before they are submitted.
The platform also selects the optimal clearinghouse for each claim based on adjudication speed for that specific payer and treatment type, and monitors every submitted claim continuously: tracking payer response timelines, flagging insurance assignment issues, and alerting on denial patterns as they emerge.
More than 95% of claims are processed entirely through this automated process, from initial submission through payment reconciliation, without any human involvement required.
What the Insurance Operations Team Does
The InsOps team is the human oversight layer in an otherwise automated system. Their role is to review, approve, and act on the specific situations where human judgment is required.
The cases that reach the InsOps team are those the platform cannot resolve on its own:
When a denial falls outside the platform's standard resolution logic, a specialist reviews it, determines the appropriate appeal path, and executes it through the relevant payer channel, including formal appeals.
When the platform identifies a submission issue it cannot auto-correct, a specialist reviews the flagged claim, determines the fix, and approves the resubmission.
Managing billing situations that fall outside the platform's trained logic: a new payer rule the models haven't yet encountered, an unusual denial pattern, or a concurrent billing conflict requiring a judgment call.
Setting up billing rules and workflows that reflect a clinic's particular payer arrangements or preferences, so the platform can handle them automatically going forward.
When automated monitoring surfaces a pattern or situation that requires a human decision before a claim can move forward, the InsOps team reviews it and determines the path.
The Resolution Process for Escalated Cases
When the platform routes a case to the InsOps team, it follows a structured four-step sequence:
Issue Surfacing
Automated monitoring identifies the claim or pattern and routes it to the appropriate work queue, with full context attached.
Specialist Review
An InsOps team member examines the case: the payer, the patient record, the claim history, and the specific reason the platform flagged it.
Decision and Assignment
The specialist determines the resolution path directly, or escalates to a senior team member or payer-specific resource if the situation warrants it.
Resolution
The appropriate action is taken: claim correction, resubmission, appeal filing, or payer communication, as applicable.
Clinics are not expected to monitor queues or initiate this process. The InsOps team owns follow-through from the point of escalation through resolution.
Escalation and On-Call Coverage
For high-complexity or time-sensitive situations, InsOps maintains a formal escalation process and a weekly on-call rotation.
When an issue is flagged for escalation, it is documented with a structured set of information: clinic name, payer, number of affected claims, issue type, complexity level, and a description of how the platform identified it. This record is then assigned to the appropriate specialist for resolution.
The on-call rotation ensures that a designated team member is available for same-day escalations at all times. When a clinic's primary contact is unavailable, the on-call specialist assumes coverage. Responsibility does not depend on any individual being available.
What This Looks Like in Practice
ABA billing involves a wide range of payer types, state-specific requirements, and authorization structures. Even with a highly automated system, situations arise that fall outside what the models can resolve. The following are examples of the kinds of cases the InsOps team has handled:
A state Medicaid plan changed its concurrent billing rules. The platform flagged affected claims and the InsOps team corrected them for all clinics before any claims were denied.
A formal payer pre-hearing process (an escalated appeal proceeding outside the platform's standard appeal logic) required a specialist to advise on how to proceed and whether the clinic needed to be involved.
A payer's requirements for a specific clinic differed from the platform's default workflow. The InsOps team built the clinic-specific configuration so the platform could handle it automatically going forward.
Automation Handles the Predictable. Humans Handle the Rest.
The platform handles what is predictable and scalable through automation. The InsOps team handles what requires human review, judgment, or direct payer engagement.
What This Means for ClinicsClinics working with Camber do not need to source internal payer expertise, track which claims have been escalated, or manage exception workflows. The platform surfaces the issues; the InsOps team resolves them.