Claims Management

We combine world-class personal support with highly trained, industry-knowledgeable professionals and leading-edge technology including industry-leading products including but not limited to HealthEdge, QNxt, Facets, etc. to deliver a comprehensive set of proven services and solutions for healthcare payers.

  • Meeting customer expectations through Flexible Architecture.
  • Addressing Deteriorating Combined Ratios by Embracing Automation and Plug-in Leakages.
  • Reducing prolonged Cycle times through efficient Process Management.
  • 20+ Payer Clients.
  • Expertise on Medicaid, Medicare, Dual, Commercial, and Marketplace LOBs.
  • Impact: 80M Patient Lives.
  • 90%+ clean claims processing in 1st pass of adjudication.
  • 10+ Solution Platforms across digital Transformation claims Management and Patient Engagement.

What we offer

Strategic Consulting

  • Strategic business case scenario planning. 
  • Claim product evaluation.
  • Claim modernization evaluation framework.

Product and Packages

  • Implementation of leading claims management products.
  • Product configuration.
  • Product competency center framework.
  • EDI system implementation and configuration.

Claim Administration

  • Claims Adjudication.
  • Claims Payments.
  • Claims Pre and Post adjudication services.
  • Claims repayment and recovery services.

Data Management and Analytics