RP Sanjiv Goenka Group

Intelligent Back Office

Uncover value
in every moment

Unlock new levels of efficiency with humanized, intelligent solutions

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More value,
in every moment

In the work you do, every interaction is valuable. There are no small jobs. No insignificant experiences. It’s why our intelligent back office is built to make it simpler for all stakeholders – your employees, members and providers — to work efficiently and optimize costs.

Together, we ensure you have the intelligent solutions and human-powered support to deliver exceptional experiences in every moment.

Future-forward claims operations for more success stories

Fast track efficiency to amplify every moment

Every claim counts. Small inaccuracies, errors, incorrect billing, and other issues can turn a small mistake into a huge mess. It’s why we use digital, AI, and analytics tools to combat inefficiencies and eliminate bottlenecks. It’s the smart support to help you keep track of every expense, while providing more accurate reimbursements to providers.

Together with our Robotic Process Automation (RPA)-based workflow solution, and an expert team with over 20 years’ experience, you’ll navigate complex claims, proactively detect fraudulent claims, and prioritize high-value opportunities – all in an efficient, frictionless experience.

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Generate greater value through process mining.

Make the most of every interaction

The need for outstanding customer experiences is on the rise, paralleled by the dynamic evolution of both the industry and regulatory landscape.

The demand for exceptional customer experience continues to grow. So too does a continuously changing industry and regulatory environment. Being able to instantly anticipate and automatically address member and provider needs and concerns is critical to success.

Take the stress out of member eligibility, enrollment and billing with a smart, AI-integrated operating model that allows you to rapidly adjust your core operations. It starts with an automated intake solution that draws upon our decades of experience in working with large Health Plans, HIX, Medicare, and Medicaid enrollment programs. Then, a touchless, paperless on-demand system to slash your cost of operations. With our convenient, multichannel solution, simplify public exchange, private exchange, member portal, online sales, and IVR (Interactive Voice Response).

With the right platform to fast-track innovation and efficiency, you’ll make every experience count: whether you’re enrolling and assisting members, monitoring and pursuing revenue or managing government interactions.

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Personalized experiences at every touchpoint

Turn insights into a better experience

When every moment counts, improving data inaccuracy and response time is critical to reducing customer frustration and improving satisfaction. With our Digitally Empowered Customer Experience (DECX) solution, you’ll be in touch with just what your customer needs across their journey, synchronize interactions across channels and deliver a seamless, powerful and omnichannel experience when it matters most.

Solution features

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Build sustainable customer trust at every turn

The right data to make the right choices to build the most important relationships

Messy or inaccurate provider data affects everything: from provider directories to claims processing, compliance, and provider communication – and, ultimately, customer trust.

GetRight, our robotic process automation solution, ensures you have the right Six Sigma processes and technology to improve the quality of your provider information and credentialing. Underpinned by AI/ML and expert associates, it helps automate and streamline credentialing/recredentialing, contracts, demographics, and delegated provider types. Suitable for multiple platforms, it even validates data against NDB and identifies mismatches between NDB and platforms. Now, you can build trust in every moment.

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Transform compliance into customer satisfaction

Create predictive efficiencies at every step

Healthcare appeals and grievances (A&G) management is a complex and intensive process, from low visibility, to constantly changing demands, regulatory uncertainties, compliance burdens and SLA requirements. We bring you the right people-powered the automation and analytics-based interventions to help you replace each, complex step with accurate prediction, intelligence and automation to make the most of every interaction.

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Smart broker support brings out their best when it matters

Shift from one-size-fits-all to personalized engagement

Our digital broker solution brings together data from disparate sources to streamline processes and provide a comprehensive view of each customer’s plans and choices. With a personalized, contextual, 360-degree view of every person’s data and plan information, our one-stop portal ensures a smooth buying process, while supporting ongoing education of brokers. Together we enhance productivity, while improving customer loyalty – no matter if we’re scheduling to quick follow-up or running a strategic marketing analysis.

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Take benefits to market faster with smarter plan management

Make the most of every benefits plan

With extensive expertise in analyzing benefit grids and configuring benefit rules on various platforms, including homegrown, core systems, our solutions enable accurate product build and improve cycle time, accuracy, and compliance.

From spectrum-of-benefit coding and benefits testing to narratives across LOBs, plan geographies, and prioritized configuration for special groups, our team and tech helps manage the process while reducing costs. Then, our “do it once, do it right” methodology delivers a better first-pass rate to consistently reduce audits, so you can manage plans smarter, simpler, faster – in all the moments that matter most.

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Maximize revenue and compliance across every line of business

Minimize risk. Maximize growth.

With more opportunity often comes more risk. We get that and prepare for it. Our end-to-end risk adjustment solutions help proactively manage risk as you grow. With our accurate, responsive adjustments to Medicare and individual lines of business, you’ll be able to maximize the impact to your revenue while ensuring stringent compliance and making the most of every system you’re managing, opportunity you’re targeting, and moment you’re capturing.  

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