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About Lumiknox

An operating partner for the U.S. healthcare back office.

We were founded by a small group of payer-operations veterans, certified coders, and applied-AI engineers who had spent two decades watching the same defects get coded around. Lumiknox exists to fix them at the source.

Our Story

Built from inside the payer back office.

Lumiknox was incorporated in Delaware in early 2024 by a team that had previously led risk-adjustment operations at two top-ten national health plans and built HEDIS engines for three regional Blue Cross licensees. We saw two things at once: the BPO model was tired, and the “AI-only” model was naïve.

Our answer is a hybrid operating model — credentialed clinical reviewers and certified coders on the front line, supported by a stack of supervised agents that handle the deterministic 70% of work and escalate the rest. The result is faster turnaround, lower per-chart cost, and accuracy that holds up under RADV-grade scrutiny.

Meet the Team
Lumiknox operations team in collaboration
What We Believe

Five operating principles.

01

Defensibility before throughput.

Every coded chart, every closed gap, every adjudicated claim must survive a regulator’s second look. Volume that won’t hold up is not productivity.

02

Humans supervise agents. Always.

Our agents act autonomously inside a tight box. A credentialed reviewer signs off on every escalation and audits a sampled %.

03

PHI never leaves the perimeter.

Client tenancy, encrypted in transit and at rest, access-logged at the keystroke level, no third-party LLMs in PHI paths.

04

Outcomes-first commercials.

Per-chart, per-member, per-gap pricing is the default. Subscription contracts include accuracy SLAs with credits attached.

05

Transparency by default.

Client portal access for every reviewer note, every agent action, every QA finding. No black-box dashboards.

06

Onshore-led, offshore-scaled.

U.S.-based clinical leadership directs delivery in Hyderabad and Manila. Time-zone follow-the-sun is a feature, not a bug.

Where We Are

Three offices. One delivery model.

Delaware HQ Headquarters

Wilmington, Delaware

Corporate, clinical leadership, client success, and U.S. legal & compliance. The buck stops here.

Hyderabad office APAC Delivery

Hyderabad, India

Our largest delivery hub — coding operations, HEDIS abstraction, data engineering, and agent ops. ~600 staff.

Manila office SEA Delivery

Manila, Philippines

Claims operations, denials work, payment posting, and English-language customer service for U.S. providers. ~250 staff.

Certifications & Compliance

Audit-ready as a baseline.

HIPAA

Privacy & Security Rules. Annual training, BAA-ready, role-based access at the application layer.

SOC 2 Type II

Independent attestation covering Security, Availability, and Confidentiality criteria.

HITRUST

CSF-aligned controls implementation; full certification roadmap in progress (target Q3 2026).

AHIMA & AAPC

100% of production coders hold CPC, CCS, CRC, or equivalent credentials. Quarterly internal CE.