In the heart of Silicon Alley in NYC, two former Amazon engineers are tackling America’s biggest challenge: making health care affordable.

Nicolas Raga and Omar Mihilmy, co-founders of Clearest Health, bring a fresh — and technology-first — perspective to an industry that has historically relied more on spreadsheets than sophisticated machine learning models. Their mission? To rebuild trust in American healthcare by applying the same technical rigor to health benefits that companies like Amazon apply to e-commerce.

The Engineer's Approach to Healthcare

"Most people don't realize that health insurance is fundamentally a data problem," explains Nico, Clearest Health's CEO. With experience building AI systems at Amazon, the founding team recognized that the healthcare industry's challenges often stem from poor data management and outdated technical infrastructure.

Their solution, powered by advanced AI, completely reimagines how claims, provider, and member data flow through the healthcare system.

Breaking Down the Technical Challenge

The complexity of healthcare becomes apparent when you consider the numbers:

• Tens of code books with hundreds of thousands of codes (ICD, HCPCS, DRG, etc.)
• Countless provider-payer-plan relationships
• Complex pricing arrangements
• Multiple stakeholders needing different views of the same data
• Strict regulatory requirements

Traditional rules-based engines struggle with this complexity, often requiring thousands of manually coded rules to handle even basic reporting. Clearest Health's approach is different: they've built data pipelines and layered on top AI models that can learn from patterns in the data, making them more adaptable and accurate than traditional systems.

The Power of Generative AI in Healthcare

Clearest Health is pioneering the use of the next generation’s artificial intelligence. While many healthcare companies are just beginning to explore AI applications, Nico and Omar have built their entire platform around advanced machine learning and data processing capabilities. This technical foundation isn't merely about operational efficiency – it represents a fundamental reimagining of how healthcare administration can work. This allows their system to:

1. Identify and correct data integrity issues automatically.
2. Provide real-time guidance to members and employers.
3. Generate actionable insights from vast amounts of healthcare data.

A Data-Driven Approach to Decisions

Perhaps most revolutionary is their approach to pricing transparency. The team has developed the next generation of "Dynamic Copay Plans" – a solution and system that uses AI to analyze provider quality, condition complexity, and treatment effectiveness to determine the optimal provider choice.

"We're eliminating the guesswork from healthcare costs," says Mihilmy, the company's CTO. "By making decisions simple and pricing clear upfront, we're not just improving the member experience – we're fundamentally changing how people interact with their health benefits."

The Future of Tech-Enabled Healthcare

As healthcare costs continue to rise – with projections showing an up to 10% increase in 2025 – the need for innovative, tech-driven solutions becomes more pressing. Clearest Health's technology-first approach suggests a future where healthcare benefits are as user-friendly and data-driven as modern consumer technology.

"We're bringing the same level of technical sophistication to healthcare people expect from their favorite apps," says Raga. "It's not just about building better software – it's about rebuilding trust in the healthcare system through transparency, accuracy, and reliability."

Looking Ahead

What makes Clearest Health's approach unique is not just their technical expertise but their understanding that healthcare's complexities require both cutting-edge technology and human insight. By combining advanced AI with deep healthcare knowledge, they show how engineering principles can be applied to solve one of society's most persistent challenges.

For employers and TPAs looking to modernize their health benefits, the message is clear: the future of healthcare administration lies in the intelligent application of technology, driven by those who understand both the complexity of the problem and the power of the solution.

Want to learn more about how Clearest Health is transforming healthcare benefits? Contact us at hello@clearesthealth.com to learn how we can transform your healthcare experience.