Member Management

Our member enrollment services reduce the administrative burden and cost to support member enrollment processes. Our eligibility and benefits configuration, backed by our knowledge-based platform, addresses the industry problem of inaccurate benefits configuration. This leads to reduction in improper claim payments and a decrease in appeals and grievances.

Case Studies
Claims Management - Process Innovation and Technology Result in Cost Reductions
The Challenge: Prohibitive labor cost and considerably higher turnaround time due to large number of manual adjudications resulting from mismatched information between enrollment data and provider data.
Provider Data Management - Process Innovation and Technology Result in Cost Savings
The Challenge: A cost intensive update process required checking data on all provider information update forms, rather than the ones which were actually changed (typically only 40%).