RP Sanjiv Goenka Group
Humana-Logo

Agenda

Date: 16th – 17th November 2023

Session Timing  Duration (Mins) Session Name
23:30 – 00:00 hrs 30 Traditional Welcome at the center and Introductions
00:00 – 00:10 hrs 10 Firstsource and Healthcare Overview
Service Offerings, Claims, Provider Services, A&G
00:10 – 00:25 hrs 15 Tea/Coffee Break
00:25 – 01:55 hrs 90 Contact Center Capability Overview Session
AI-First Health Plan Operations Transformation Assets
•Process Mining Inferences
•GenAI – Benefits Inquiry and Claims Status Inquiry Copilot
•Instructional Design Copilot
•Hiring and Training Simulator
•Smart Mailbox Copilot
•Guided Agent Navigation Support (Yonyx and SONAR)
•Visual IVR and OnDemand Apps
•Conversational AI Tools for Superior Experience
01:55 – 02:45 hrs 50 Talent Management
Voice Talent Acquisition, Retention, Training and Quality
02:45 – 03:30 hrs 45 Operations Session
Discussion with Healthcare contact center associate
03:30 – 03:45 hrs 15 Tea/Coffee Break
03:45 – 04:00 hrs 15 Wrap-Up and Next Steps Discussion
04:00 – 04:30 hrs 30 Drive to the Hotel from FSL Facility

Team Introduction

Picture of Venkatgiri Vandali

Venkatgiri Vandali

President - Healthcare

Picture of Prashanth Nandella

Prashanth Nandella

Chief Operating Officer​

Picture of Rajesh Reddy

Rajesh Reddy

Account Partner

Picture of  Sundari Sethuraman

Sundari Sethuraman

Intelligent Back Office Operations

Picture of Priyanka Grover

Priyanka Grover

Healthcare Solutions

Picture of Nikhil Mendhi

Nikhil Mendhi

Claims Transformation

Picture of Shamba Gupta

Shamba Gupta

Infosec & Compliance

Picture of Reetoopan Kaushik

Reetoopan Kaushik

Training and Capability Development

Picture of Ramanathan Nachiappan

Ramanathan Nachiappan

Human Resources

Picture of Dinesh Ramesh

Dinesh Ramesh

Claims Operations

Location Overview

Talent Leadership

Talent Acquisition

Hiring the right talent is key to success of our programs

Talent Management and Retention

Employees Comes First

Capability Development

Learning Journey of our Employees

Inclusion and Diversity

We fully embrace an inclusive workplace culture

Our Spectrum of Offerings across the Health Plan Value Chain

Intelligent Back Office

Simplifying clinical and financial experience for patients and healthcare providers

  • Claims Operations
  • Enrollment Operations
  • Membership and Billing
  • Provider Data Management
  • Provider Credentialing
  • Digitally Empowered Contact Center – Member and Provider services
  • Complaints, Grievances and Appeals

Platform Based Services

Improving customer experience, driving digital transformation by leveraging Platforms and delivering underlying process efficiencies

  • Medicaid Redetermination
  • Digital Intake - Claims, Enrollment, Auth, Appeals, HEDIS, Correspondence
  • Corporate Mail to Email Digital Post-office Solution
  • Core Admin Business Process as a Service (BPaaS)

Digital Health Data & Analytics

Ensuring a seamless digital experience for Patients across all channel

  • Medical Devices
  • Patient Outreach
  • STAR, HEDIS
  • Risk-Adjustment
  • Medication Adherence
  • Process Mining
  • Predictive & Preventive AI
  • Generative AI Copilots
  • Intelligent Automation

Industry Analysts and Clients are endorsing Firstsource’s approach

Leader in Healthcare Payer Operational Transformation

Leader and Star Performer in Healthcare Payer Operations

logo 5

Innovator in Claims Processing Transformation

Logo 3

#1 in Eligibility and Enrollment Services

Leader/Rising Star in Healthcare Digital Services

Rising star in Payer BPaaS Services

Placed in BPS Top 10 Service Providers by Growth

Bloomberg

Recognized on Bloomberg Gender-Equality Index 2023

Intelligent Back-Office Operations

Claims

Transform fragmented, manual and error-prone claims operations into Digital-First Operating Model

Provider Operations

Turn ordinary PDM and Credentialing processes into extraordinary provider & member experiences

Contact Center

Transform every Member and Provider call to an exceptional experience that builds loyalty

Enrollment and Billing

Transform E&B transactions to delightful member experiences while providing timely access to care

Digital Intake

Turn ordinary mailroom processes into extraordinary experiences for everyone

FirstSenseAI

Intelligent Back-Office Operations

FirstSense AI - Suite of Services across the Claims Operations Value chain Claims Intake Claims Adjudication Claims Payment & Financials Appeals & Grievances Claims Adjustment Claims Payment /Recovery ClaimsAudit Payment Integrity Click Here 01 05 03 07 02 06 04 08 Sympraxis® - Proprietary purpose-built data capture platform with multiple OCRs, AI/ML, Automation, and Analytics capabilities Enso Claims AI - Predicts and resolves claim suspensions without manual Intervention and executes real-time intelligent claim edits Enso Claims AI - Predicts and resolves claim suspensions without manual Intervention and executes real-time intelligent claim edits Generative AI –Automated Quality Audits Enso Claims Audit - Predicts and identifies claims with potential errors and provides reasons for errors Enso PaymentIntegrity COB - Predicts potential COB in real-timeusing a combinationof Member life eventsand claim data and recommends future actions SONAR - SOP Navigation & Review for manual adjudication SONAR - SOP Navigation & Review for manual adjustments Enso Appeals & Grievances - Predicts, classifies, and flags claims for potential appeals and grievances using LLMs and NLP SONAR - SOP Navigation & Review for over/under payments