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.
Stay ahead with Firstsource
- Accurate, on-time payment processing
- Enhanced productivity and quality
- Continuous reduction to cost of operations
- Lower Adjustment Rates
- Increased Auto-Adjudication
- Reduced interest payments and penalties
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.
Stay ahead with Firstsource
- Elevated customer experience – NPS/CSAT
- Accelerated enrollment process
- Lower cost of enrollment and billing operations
- Growth in membership
- Improved CMS Acceptance Rate
- Reduced interest payments and penalties
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
- 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
- Boost First Call Resolutions (FCR) and NPS/SCAT
- Reduce cost of operations
- Heighten customer experience, reduce churn
- Optimize associate bandwidth, allowing them to focus on more complex queries
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.
Stay ahead with Firstsource
- End-to-end Credentialing/ Recredentialing support with ongoing sanctions monitoring
- Superior Provider data accuracy and process efficiency
- Enhanced quality, productivity and turnaround
- Auto fetching and updating of multiple screens
- Reduced manual intervention for faster cycle times
- Reduced rework for downstream Claims and Quality Management Operations Learn more
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.
- 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
- 25%-30% increase in A&G SME efficiency
- Enhance NPS/CSAT by 10%-15% to boost Member, Provider and Broker experience
- Reduce operations costs per appeal by 20%-25%
- Amplify appeals processing accuracy and response time
- Reduce Auto Forwards and improve compliance
- Minimize penalties
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.
- 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
Stay ahead with Firstsource
- Reimagined Broker/ Agent experience
- Advanced reporting and business intelligence for in-depth insights
- Digital archive of all customer interactions in one place
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.
Stay ahead with Firstsource
- Amplify data accuracy and strengthen compliance
- Reduce claims errors
- Lower claims recoveries
- Expedite speed to market
- Enhance Member experience – NPS/CSAT
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.
- Prospective and retrospective risk adjustments
- Record retrieval, submission and reporting
- Coding services
- Forecasting of risk trends and care interventions
- Support for Risk Adjustment Data Validation (RADV) Process
Stay ahead with Firstsource
- Enhance revenue accuracy
- Reduce operational costs
- Augment risk scores and prevent revenue leakage
- Drive transparent operations
Pivot to Digital. Challenge the status quo
Upend traditional healthcare delivery with our Intelligent Automation solutions that integrate Robotic Process Automation (RPA) with Artificial Intelligence (AI) to drive unparalleled operational efficiencies, productivity and patient care.
Holly Hans, Claims Vice President at CareSource
Bringing strategic clarity and deep industry perspective to CareSource — helping shape priorities, guide decisions, and power what’s next.