RP Sanjiv Goenka Group

Platform-Based Services​ for Health Plans

Optimize every moment

Unleash the power of platforms. Gain new insights. Drive new levels of growth.

BPaaS ​

Big Win in Healthcare BPaaS!

Leading health insurer selects Firstsource for large scale transformation

Deliver exceptional experiences

Jumpstart innovation and accelerate transformation with intelligent, end-to-end platforms that optimize workflows, enhance efficiencies, and drive significant cost savings so that you can deliver a better member & provider experience with every interaction.

Automate tasks, reduce manual efforts, and eliminate errors so that you can free up resources for strategic initiatives and drive innovation.

Stay ahead of the competition, seize new opportunities, and scale your business with end-to-end platforms that turn traditional workflows, siloed processes, and disjointed customer insights into powerful models, made for every moment.

Create a smarter, more human mailroom

The right platform to drive frictionless, smart processes at every step

The future of mailroom operation calls for higher accuracy, productivity, security, assured savings, and simplicity. But today, slow downstream business processes and traceability, compliance and member experience issues are still some of the most common risks traditional mailroom operations face.

Our platform-based digital intake solution for various input formats across health plan functions drives more results with each interaction. It starts with our digital mailroom and data capture services, underpinned by Sympraxis® V6, a purpose-built platform for at-scale smart intake. Powered by our ML technology, Multi-OCR, RPA, analytics, reporting, process mining, and a rules-based high-performance workflow engine, we support responsive, streamlined mailroom and data capture processes, corrections and quality audits. Now, operations get simpler – and smarter – with every touch.

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Turn traditional mail into smart, personalized interaction

Get critical information to stakeholders, faster

Many businesses continue to rely on slow, inconsistent physical mail for interoffice communication between employees, departments and back-office core admin workflow.

Our digital post office solution seamlessly integrates each of these siloed interactions, so you can engage every stakeholder faster and more securely. With one single, high speed and centralized platform, you’ll be able to track, audit, monitor, and make every interaction valuable and effective, whether you’re communicating with individuals, departments, or groups.

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Enhance member experience and retention through proactive digital engagement

Medicaid enrollment and eligibility processes require quickly processing significant volume backlogs within mandated timelines, while providing members.

MReD, our modularized Medicaid redetermination solution, blends personalized engagement with proactive outreach to help states and health plans drive timely redeterminations, without compromising ongoing vaccinations. It helps members seamlessly navigate the redetermination process. With outcomes typically improving within three months of implementation, you’ll know you’re maximizing every member moment and building success stories at every turn.

Optimize your business operations from end-to-end

Transform your business and strategy from the core

In today’s market, if you’re not innovating to deliver new value, you’re falling behind. We make it seamless to do both at the same time through helping our clients reinvent conventional business processes and workforce models to better empower people, their ambition and ability to do amazing things. Together, we manage increasing volume and complexity, while keeping costs down and improving quality of services.

Our Core-Admin Business Process as a Service (BPaaS) moves your operations away from traditional outsourcing to an outcome-based, end-to-end platform enabled strategy. A layered operating model, it brings together multiple capabilities with a simplified engagement model and financial construct. We improve infrastructure, platform, and operations, enabling more meaningful SLAs and influencing better downstream outcomes based on upstream levers. With more accuracy across providers, benefits and claims, you’ll experienced increased capacity for innovation, without compromising on delivering value in the moments that matter.

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Integrate compliance and member experience into one, powerful platform

Transform all your processes and operations into one, powerful platform with our Medicare Health Plan in a Box offering, from end-to-end solutions plan setup to hosting, IT infrastructure, application management, data management, business process services, business dashboards, consulting, and training.

Backed by seasoned Medicare SMEs, the IT and operations team provides services across enrollment, premium billing and reconciliation, claims adjudication and adjustments, product configuration, member and provider services, appeals and grievances, provider contracts, credentialing and provider data management. And, our Medicare plan specific services include Medicare risk adjustment, STAR rating, and CMS reporting. 

Together with a simplified per member per month (PMPM) based cost structure that ensures low setup costs and CapEx, our platform-enabled process optimization makes every member and provider experience an exceptional one.

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Simplify Medicaid operations at every step

Create responsive, personalized consumer-facing operations

Our end-to-end solutions help health plans integrate their portfolio with state Medicaid programs, from Medicaid plan setup, to hosting, IT infrastructure, application management, data management, business process services, business dashboards, consulting, and training.

Together with our Medicaid SMEs, IT and operations experts, we streamline Medicaid from enrollment to billing and reconciliation, claims adjudication and adjustments, encounter submission, product configuration, member and provider services, appeals and grievances, provider contracts, credentialing, and provider data management and state reporting. Our goal? To turn complex, time-consuming operations into streamlined operations with positive interactions at every step.

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Transform the claims lifecycle into a single, intuitive process

Make every interaction fast, effective and transparent

Expediting appeals and grievances and rectifying complaints with quick, precise resolution is critical for your business. So, our configurable and automated healthcare payer BPaaS solution provides unparalleled transparency and business controls for cases ­– creating smart, responsive efficiencies from intake to disposition.

It starts with automatically prioritizing appeals and grievances. Then, with reducing manual intervention and ensuring members and providers get the coverage and customer service they need and expect. Finally, we integrate a smart feedback loop for continuous improvement across admin processes and appeals and grievances data to ensure every interaction has the potential to increase member satisfaction, proving every moment matters.

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Make every provider interaction count

Our Provider management platforms put your focus where it matters most

Our Provider Lifecycle Management Business Process as a Service (PLM BPaaS) solution supports end-to-end provider network management and credentialing, creating opportunities to reduce the cost of operations for provider credentialing, monitor provider networks to ensure consistency.

Powered by our people-powered, intelligent processes, the platform auto-fills most applications, decreases manual effort, and reduces errors by leveraging best practices, so you can shift your focus to quality providers, to make the most from every moment.

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Empower brokers to optimize every interaction

Help your brokers build valuable experiences

When your business growth depends on your brokers, it’s important to help make every conversation, interaction, and touchpoint count. It’s why our fully integrated broker management solution consolidates sales channel data sources, manages broker operations, and optimizes incentives and compensation. The customizable solution manages commissions, brokerages, and incentives, enabling on-time, accurate, and compliant operations, providing a better, smarter, experience from end to end. Integrated with various modules to support multiple devices, it offers a single access point to improve transparency among multiple stakeholders by providing real-time data reporting and workflow management, custom marketing materials, and more.

 

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