Inside Credentialing: Where AI Delivers Measurable ROI for Health Plans

In this Bright Spots in Healthcare episode, host Eric Glazer sits down with three leaders reshaping one of healthcare’s most overlooked — yet mission-critical — functions: provider credentialing.

Credentialing is the quiet infrastructure of trust in healthcare. When it’s done right, patients get timely access to high-quality care, providers get paid faster, and health plans stay compliant. When it fails, backlogs grow, compliance risk skyrockets, provider satisfaction plummets, and member access suffers.

Joining Eric for this discussion:

• Sandra Clarke, Former CFO & COO, Blue Shield of California

• Brett Dooies, Head of Product, Verifiable

• Janan Dave, VP of Operations, Verifiable

Together, they explore how AI and automation are transforming credentialing from a slow, manual compliance task into a strategic capability that improves efficiency, trust, and network readiness.

In this episode, you’ll learn:

• Why credentialing sits at the intersection of compliance, provider experience, and member access

• How legacy processes, staffing limits, and messy data create hidden risk, and why backlogs can grow like quicksand

• Practical ways health plans are applying AI to reduce verification time, speed onboarding, and triage high-risk cases

• Why the most successful plans treat credentialing as infrastructure, not paperwork

• Key metrics to track when modernizing credentialing, including turnaround time, backlog clearance, audit readiness, and provider experience

• What to automate first,  and why humans still play a critical oversight role

Bright Spots include:

• 97% automated verification in seconds across millions of records monthly

• New staffing and automation models that increase speed without compromising compliance

• Real-world examples where AI prevented risk exposure and accelerated network growth

• Leadership lessons in adopting AI responsibly and avoiding the “lift-and-shift” trap

 

This conversation offers payer leaders a real-world playbook to modernize credentialing and strengthen the foundation of your healthcare organization.

Panelist Bios:

Sandra Clarke is a healthcare executive and board advisor with over 25 years of experience leading finance, operations, and large-scale transformation across payer, provider, and life sciences organizations. As former CFO and COO of Blue Shield of California, she oversaw $25B in annual revenue and spearheaded initiatives delivering $700M in annualized savings while reimagining the company’s pharmacy care model. Clarke has also held senior leadership roles at Daiichi Sankyo and Philips Healthcare and serves on multiple healthcare boards. She holds degrees from MIT, Bentley University, and Seton Hall University School of Law.

Janan Dave is the VP of Operations at Verifiable, a start-up offering software and services solutions for healthcare organizations to ease the challenges surrounding provider network management. Janan has a background in public health and health policy, and has spent the last decade helping scale operations at various healthcare startups. She is passionate about building smart solutions to reduce waste in the healthcare system, and promote better care especially for the aging population, family caregivers, and women. Janan studied public health at the University of Pennsylvania, and lives in Brooklyn, NY.

Brett Dooies is the Head of Product at Verifiable, where he leads the development of AI-powered solutions to simplify healthcare credentialing and monitoring. With a decade of experience building enterprise software, he specializes in applying advanced AI and analytics to enhance the customer experience and deliver transformative solutions. Drawing on his background in modernizing banking software, Brett is dedicated to creating products that drive operational excellence, uphold regulatory compliance, and improve data accuracy for Verifiable’s partners, helping them scale with confidence in a complex ecosystem.

Resources:
MIT Sloan “Internet of AI Agents: State of AI in Business 2025” report finds that although over 80 % of organizations have piloted generative AI tools, only around 5 % have achieved meaningful business transformation—a gap dubbed the “GenAI Divide”.

It highlights that the primary barrier isn’t model technology or regulation, but rather the failure of AI systems to integrate deeply into workflows, learn from feedback, and scale beyond the pilot stage.

https://mlq.ai/media/quarterly_decks/v0.1_State_of_AI_in_Business_2025_Report.pdf

Thank you to our Episode Partner, Verifiable:

Verifiable is a credentialing and network monitoring platform built to help healthcare organizations optimize operations with error-free, fast verifications and to stay compliant with ease. Backed by their in-house NCQA certified credentialing team that bring a combined 60+ years of experience, Verifiable’s innovation supports managing trusted networks at scale through 97% verification automation in seconds with millions processing each month. Verifiable works with leading healthcare organizations such as Humana Dental, Zelis, Talkspace, Headway, Empower Pharmacy, and many others.

 

Learn more about them at https://verifiable.com/

Want to go deeper or schedule a briefing with Verifiable?

Email [e-mail] and we’ll coordinate time with the Verifiable team to discuss how their approach can help your plan reduce costs, accelerate onboarding, and strengthen network integrity.

About Bright Spots Ventures:

Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.

 

We help healthcare leaders discover what’s working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the “bright spots” in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.