Healthcare Claims Administration | Healthcare Claims Processing & Adjudication

Drive continuous improvement, become a top performer

Implement operational strategies that stand the test of time and deliver critical business outcomes by driving underlying process efficiencies. Our Core-Admin services support your System of Engagement (SoE) and System of Records (SoR) with transformative digital-first services, driving process effectiveness, strategic agility, and enhanced service efficiency.

Backed by digital technologies such as Process Mining, AI/ML, Automation, and Analytics, our services are designed to help you grow, innovate, and improve both the Member and the Provider experience. The result: drive sustained growth to advance your business in an ever-evolving market.

Frictionless claims operations for transformational experiences

Combat inefficiencies and eliminate bottlenecks with Digital + AI + Analytics

Don’t lose millions of dollars to inaccuracies, errors, incorrect billing, overpaid medical claims, missed discounts, and other issues. Keep expenses under control while providing accurate reimbursements to providers. Our expert team with over 20 years of experience can help you navigate complex claims processing and enhance transparency leveraging digital technologies, including process mining, predictive analytics, visual dashboards, AI/ML, and intuitive workflows.

Our Robotic Process Automation (RPA) based workflow solution enables you to assess claims with greater accuracy, proactively detect fraudulent and erroneous claims, and prioritize high-value claims.

Stay ahead with Firstsource

Create a great first touchpoint experience

Leave a lasting impression, kindle customer loyalty

As the demand for exceptional customer experience continues to grow amidst an ever-changing industry and regulatory environment, promptly and accurately addressing member needs and concerns will be key to success.

Take the stress out of member eligibility, enrollment and billing with the help of our agile operating model that allows you to flex your core operations. Our associates, empowered by leading-edge technology and Intelligent Automation solutions, are skilled in enrolling and assisting members, monitoring and pursuing revenue, and managing government interactions around federal benefits.

Our automation intake solution draws upon our decades of experience in working with large Health Plans, HIX, Medicare, and Medicaid enrollment programs. It provides a touchless, paperless on-demand system to slash your cost of operations. The convenient, multichannel solution spans Public Exchange, Private Exchange, Member Portal, Online Sales and IVR (Interactive Voice Response).

Stay ahead with Firstsource

Digitally Empowered Contact Center for a brilliant customer experience

Turn customer interaction insights into enriched experiences

Improving data inaccuracy and response times is fundamental to reducing customer frustration and improving satisfaction. Rapidly access your customer’s intent across the customer journey to synchronize interactions across channels and deliver a seamless experience. Our Digitally Empowered Contact Center (DECC) solution enables you to better understand the customer journey across touchpoints to offer a seamless omnichannel experience.

Solution features

Omnichannel (voice, chat, email, text, portal, social media), biometric authentication, digital self-service channels for Members, Providers and Brokers, enabled with AI/ML capabilities.
Associate desktop solution includes unified screen desktop with automated call summary, next best action, call and screen recording, and sentiment analysis.
Other technology components include cloud-powered platforms and CRM solutions, outbound call solutions, visual analytics, predictive and prescriptive analytics, sentiment analytics, agent productivity tools for remote and in-office monitoring, and customer 360 views.

Stay ahead with Firstsource

Build customer trust while meeting compliance and quality mandates

Don’t let bad Provider data cost you millions

Bad Provider data impacts multiple aspects – Provider directories, claims processing, compliance, and Provider communication – and ultimately, customer trust. Improve the quality of your Provider Information and Credentialing through proactive management, Six Sigma processes, and the right technology solution.

Our Robotic Process Automation solution GetRight, underpinned by AI/ML and expert associates, helps automate and streamline credentialing/recredentialing, contracts, demographics, and delegated provider types. Suitable for multiple platforms, the solution validates data against NDB and identifies mismatches between NDB and platforms.

Stay ahead with Firstsource

Harness digital synergies to transform complaint resolution

Meet the twin goals of boosting customer satisfaction and compliance

Constantly changing demands, regulatory uncertainties, compliance burden, SLA requirements, risk of penalties, and lack of visibility and reporting – all of these make healthcare appeals and grievances (A&G) management a complex and intensive process. All the more so when handled manually. Reimagine the process with digital operations comprising multiple automation and analytics-based interventions.

Intelligently allocate complex A&G requests
Predict which claims and Prior-Auth rejections will turn into an appeal
Assess the propensity of an appeal to go to Level 2 & 3 due to an inaccurate disposition
Forecast volumes and capacity management
Avoid missing regulatory SLAs with a TAT prediction model
Reduce human intervention through automatic document classification, routing and case creation
Expedite priority cases, reducing wait-time and bottlenecks
Enable proactive compliance and reporting with ad-hoc analytics as well as “one-click” access to standard reports

Stay ahead with Firstsource

Digitize broker support. Empower them to do what they do best

Shift from cookie-cutter to personalized experience

Provide a personalized, contextual, 360-degree view of customer data and plan information, ensure a smooth buying process, and support ongoing education of brokers. Our Digital Broker solution brings together data from disparate sources to streamline processes and provides a comprehensive view of customers’ plans and choices, enhancing productivity and building a loyal customer base. A cost-effective, one-stop portal for customer and policy information, history of activities, follow-up schedules and marketing analysis, the solution offers:

Customized plan comparison supports more than 5000 plan combinations
Intuitive support for plan recommendations, claims assistance, and negotiations of premium
Easy integration with enterprise systems
End-to-end support for sale of policies
Full cycle trading from quote to insurance, endorsement, claims, renewals
Unified workflow for each customer
Dashboard to analyze and evaluate reports and offer comprehensive insights into the conversion process

Resource Type

Core Admin Services

Transformative digital solutions for next-gen operations

Stay ahead of current and future market requirements

Drive continuous improvement, become a top performer