CASE STUDY
Industry:
Health Insurance
Products / Services:
Medicare BPaaS
Automated and transformed the Membership management of a prominent Health insurer
Client Background
Client is a healthcare company serving Medicare population with an aim to make healthcare easier and more affordable. The client is a leading single-state Blues plan that provides best in class healthcare to its members.
Client Requirements
With the objective to offer unique member experience, the client wanted to modernize the enterprise to achieve growth as well as remain compliant and secure. The client aimed at supporting each business segment to facilitate value based care and increase speed to market.
100% CMS compliance solution adhering to the requirements and regulatory mandates
Well integrated solution addressing complex MA requirements and supporting scale to meet growth plans
Integrated Solution for Eligibility & Enrollment, Premium Billing, Reconciliation, Encounter Data Processing & Risk Adjustment
Solution Highlights
Our integrated solution helped client achieve growth as well as remain compliant and secure. Using our user-friendly platform, each business segment can now facilitate value-based care with increased speed to market and unique member experience.
Sell
Encompasses online web application and broker management portals integrated with Member360
Enrollment
Eligibility & Enrollment, ID cards enhancement and correspondence management through Member360
Service
Back office support services for Enrollment and Revenue reconciliation processes
Provider
Provider portal enabling provider credentialing and claims status update
Claims
Highly configurable and scalable solution supporting multiple line of businesses (LOBs)
Finance
Top to granular view of membership financials providing holistic understanding of financial performance