American healthcare generates roughly $1T in administrative costs each year, a burden that has grown steadily even as the industry has added both staff and technology to manage it. At the center of that cost is a structural gap: the contracts that govern payment between payors and providers have never been directly connected to the claims systems that execute those payments, leaving both sides to reconcile disputes through manual processes rather than a shared source of truth. The American Medical Association has estimated that one in five commercial claims is processed inaccurately, a rate that has barely moved in a decade, while providers lose an estimated 3% to 10% of net revenue annually to payments that deviate from what their contracts actually require. Kubera Health addresses this at the source by ingesting a health system’s full portfolio of payor-provider agreements and turning them into structured, computable rules that run continuously against claims and payment data – surfacing discrepancies with the contract logic attached before disputes accumulate. The platform covers the full contract-to-payment lifecycle: contract intelligence and modeling, continuous payment auditing, and payor policy tracking, all built on a HIPAA- and SOC2-compliant infrastructure that customers can reach live monitoring within 90 days. Every customer to date has expanded their engagement with Kubera, and the platform has processed more than $3B in payments.
AlleyWatch sat down with Kubera Health Founder and CEO Roja Garimella, MD to learn more about the business, its future plans, recent $6.5M seed round that brings total funding to $9.5M, and much, much more…
Who were your investors and how much did you raise?
We raised a $6.5M seed round, led by Upfront Ventures, with Company Ventures, Dria Ventures, and SemperVirens Venture Capital participating.
Tell us about the product or service that Kubera Health offers.
Kubera Health is the contract-to-payment system of record for American healthcare — contract and payment intelligence for providers and the organizations that serve them. We turn every payor-provider contract into structured rules that run against claims and financial data, so that payment issues can be audited and reconciled against the contract itself.
What inspired the start of Kubera Health?
I trained as a medical doctor and started my career on the clinical side, but I’d had a long-standing frustration with why the administrative side of healthcare is so hard. Working inside large enterprises like Humana and Commonwealth Care Alliance, I saw firsthand how difficult the operations around contracts and data really were — the hardest problems weren’t clinical, they were financial. Kubera exists to fix one of the biggest issues within healthcare: how care gets paid for and how expensive that process is.
How is Kubera Health different?
Most companies in this space work downstream — in the claim queue, the denial workflow, the billing staff. We work upstream, at the contract layer where the rules originate. Providers lose revenue because they don’t fully know what their contracts say, can’t model what they should be paid, and have no systematic way to tell when a payment deviates from contracted terms. By making those contract terms computable, measurable, and enforceable, we help prevent that leakage structurally rather than chasing it after the fact. We’re building infrastructure, not another workflow tool.
What market does Kubera Health target and how big is it?
U.S. healthcare spending is around $5 trillion a year, and roughly a quarter of that — close to $1 trillion — goes to administration rather than care. We’re focused on the financial layer inside that: the contracts, claims, and payments that move money between payors and providers, which alone runs about $200 billion a year across more than nine billion claims. It’s a massive market, and it’s still remarkably dominated by very old and disconnected technology.
What’s your business model?
We charge a subscription fee based on volume, scale, and complexity, and we’ve increasingly been moving into upside arrangements and shared-risk models alongside that.
How are you preparing for a potential economic slowdown?
We’re full steam ahead on growth right now. Healthcare generally fares well in challenging markets, and administrative spend has only continued to increase. As conditions get tougher and government funding to healthcare programs comes under pressure, hospitals and clinics feel every dollar more acutely — so we’re preparing to help more of them recoup the payments they’re owed and negotiate stronger contracts to weather harder economic times.
What was the funding process like?
We’d worked closely with most of these investors for over a year prior, so there was already a foundation of trust and a shared understanding of what we were building that made the process efficient.
What are the biggest challenges that you faced while raising capital?
Raising capital is always a distraction from the core business, and everything else keeps moving full steam ahead regardless, so the hardest part was keeping all the balls in the air at once. There’s also a real education curve: this is a complex, unglamorous corner of healthcare, and part of the work is helping investors understand why the contract layer is the right place to build.
What factors about your business led your investors to write the check?
We had strong pilot conversion and net revenue retention across our first batch of customers, and we’d proven we could get deep into sales processes with some of the largest healthcare enterprises in the country.
We had strong pilot conversion and net revenue retention across our first batch of customers, and we’d proven we could get deep into sales processes with some of the largest healthcare enterprises in the country.
What are the milestones you plan to achieve in the next six months?
We have several flagship feature releases coming over the next few months — including work in agentic revenue recovery that I’m especially excited about.
What advice can you offer companies in New York that do not have a fresh injection of capital in the bank?
Build for your customers, and keep your team in the loop every step of the way. It sounds simple, but those two habits are what keep you honest and aligned when you don’t have a fresh injection of capital to paper over mistakes.
Where do you see the company going now over the near term?
We’re building toward becoming the system of record that healthcare payments actually run on. Near term, that means supporting more customers and variations of contracts/payment models.
What’s your favorite spring destination in and around the city?
Red Hook — best views in the city, great food, and so many fun places to explore.
