Intelligent Back Office
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.
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 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).
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.
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.
Create accurate and competitive health plans. With extensive expertise in analyzing Benefit Grids and configuring Benefit Rules on various platforms, including homegrown core systems, we enable accurate product build and improve cycle time, accuracy, and compliance. Our “Do it once, do it right” methodology delivers a better first-pass rate to consistently reduce audits. Our services across the spectrum of benefit coding, benefits testing, and narratives across LOBs, plan geographies, and prioritized configuration for special groups help manage and reduce costs.