Deliver a Consumer Experience to Members and Providers

Today’s health plan administrative roles have expanded beyond traditional claims processing, enrollment and payment accuracy. The role of insurance provider has shifted, and the additional duties as care provider demand new approaches. You must design products and services, deliver information and effectively engage with members and providers while meeting a myriad of new federal and state regulations. The significant upsurge in consumerism, technology disruption, price sensitivity and the need for newer models of service delivery are forcing you to focus more on a wide range of business outcomes than ever before. We can help. For more than 30 years, our health plan solutions team has implemented the processes and technologies that bring about real transformation for health plans of all sizes.

Our end-to-end health plan services, including our Digital BPaaS offering, help you streamline operations, improve productivity and strengthen cash flow, allowing you to stay competitive and improve member satisfaction. Digital BPaaS delivers modular, end-to-end business process as a service across the front-, middle- and back-office functions to foster digital consumerism experiences with impactful, real-time analytics, and automated, intelligent and multi-channel customer support. The solution also delivers quick access to information enabled through a seamless integration of the core admin platform, a host of our IP and third-party applications, portals and cloud infrastructure. This allows you to focus on strategic initiatives that drive growth and care quality and start realizing value-based care and business outcomes in as few as 90 days.

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Digital Transformation and Cost-Effective Care

In new research, NTT DATA and ISG explore insights to help health plans move to a member-centric model, adapt to new technologies, acquire new skills, enhance outcomes and lower costs – all while improving services and fostering resilience.

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Our Services

Front Office

We offer a wide range of administrative solutions for health plans, including sales and enrollment call centers and direct marketing.

Middle Office

Lower costs by focusing on improved outcomes with care management, disease management, utilization management, on-site nurse support and telemedicine.

Back Office

Streamline claims processing, billing, customer service, enrollment and more, and adopt payment integrity solutions that add value.

Everest Group named us a Leader in Payer Digital Services in its PEAK Matrix® Assessment. – February 2020

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Build a virtual workforce through automation, and take multi-tasking to a new level.

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