Business Process Solutions for Health Plans

Stay competitive with streamlined operations and increased productivity

Industries/ Healthcare & Life Sciences/ Health Plans /Business Process Solutions for Health Plans

Today’s health plan administrative roles have expanded beyond traditional claims processing, enrollment and payment accuracy. The shift from an insurance provider to additional role as care provider demands new approaches to how you design products, deliver information and engage with consumers while meeting a myriad of new federal and state regulations.

For more than 30 years, our Business Process Outsourcing team has implemented the processes and technologies that bring about real transformation for customers of all sizes. Our end-to-end administrative services help you streamline operations, improve productivity and strengthen cash flow to stay competitive and improve member satisfaction.

Integrated business process and technology solutions to enable information-driven healthcare throughout the healthcare ecosystem.

Support strategies for interoperability, scalability, and cloud computing

Reduce dependence on legacy application portfolio

Imbed process maturity and innovation into service delivery

Our solutions:

Front Office
We offer a wide range of solutions to meet the administrative needs of health plans.
  • Sales call center
  • Enrollment call center
  • Direct marketing
Middle Office
Solve the cost of care issue with solutions focused on improving services and members’ health and well-being.
  • Care management
  • Disease management
  • Utilization management
  • On-site nurse support
  • Telemedicine
Back Office
Streamline core processes such as claims processing, billing, customer service, enrollment and more, and adopt payment integrity solutions that add value.
  • Mail room (print and fulfillment)
  • Claims processing
  • Premium billing and collection
  • Plan updates
  • Provider services
Business Process Management Suite
Manage your processes with our end-to-end service delivery and transformation tool.
  • Workflow
  • Knowledge management and learning portal
  • Client extranet/global collaboration portal
  • Reporting and dashboards
  • Automated full-time employee
  • Integration layer
  • Access layer
Automated Full-Time Equivalent
Get a combination of tools that work across various vertical and horizontal processes.
  • Medical coding
  • Demo entry
  • Payment posting
  • Charge entry
  • Claims processing
  • Adjudication
  • Account receivables
Staffing Solutions
Mobilize resources on demand. We can provide highly skilled staff on a temporary or permanent basis to work under your direction. Staff can be on site within days of your request.
  • Claims staff support
  • Claims and call center audit
  • Call center staff support
  • Configuration, business analysis and project management
  • Eligibility and enrollment administration
  • System conversion
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Business Process as a Service (BPaaS)
The revolutionary new service delivery model that provides a software application, business operations staff, and an infrastructure platform, all at an economical consumption-based PMPM cost.
  • Rapid value realization liberates resources for core business and investment
  • Supports strategies for interoperability, scalability, and cloud computing
  • Diversion of responsibility for business process, applications, and infrastructure to service vendor
  • Reduce dependence on legacy application portfolio
  • Imbeds process maturity and innovation into service delivery
  • Aligned incentives between client and service vendor
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