Health Plan Administration Services
Advanced technology and expert services to help improve efficiency, modernize operations and accelerate market expansion.Contact Us
Unlock Operational Agility
The operational ecosystem in which payers function is critical to overall performance, service quality, growth and future-readiness. In today’s increasingly competitive marketplace, it’s imperative to keep up with evolving technology demands and leverage expert guidance and support — to simplify and streamline workflows, enhance interoperability and foster the digital exchange of information.
Seamlessly combine technology, process and people to support a wide range of needs.
Technology to optimize your operations
A recognized leader in Healthcare Business Processes, healthcare payers have tapped into our technology solution for 40+ years to streamline their operations, manage membership and enhance agility to enable growth.
Processes to ensure compliance and simplify plan administration
Our robust library of automated processes supports efficient, compliant health plan administration. From digital conversion of inbound paper claims to claims adjudication and supporting member and provider inquiries, we help payers elevate their performance and optimize their operations.
People to support you every step of the way
The seasonality of many healthcare insurance processes, combined with regional access limitations, often create staffing challenges for health plans. Conduent’s deep industry experience and global footprint lets us easily scale staff to support a wide range of health plan operational needs, from resolving enrollment application gaps to working pended claim queues and supporting appeal and grievance processes.
Conduent Named a Rising Star in 2021 ISG Provider Lens™ Healthcare Digital Services ReportRead Blog
Expert support for a diverse range of needs:
Claims Intake and Automation
Health plans look to us for end-to-end services spanning across the intake, data extraction and processing of enrollment and claims communications — both paper and digital. Powered by the latest AI and ML technologies, our automated solutions improve document processing speed and accuracy — reducing costs while enabling better customer experiences.
Member Enrollment Services
The growth of individual enrollment plans and shortened enrollment periods is challenging membership departments. We provide a suite of solutions to streamline application processing, speed new member acceptance and enhance underwriting consistency while reducing costs.
Our healthcare payment accuracy solutions combine multiple data source and proprietary technologies with extensive industry expertise and a nationwide footprint to help health plans identify and recover more overpayments while minimizing both provider and member abrasion.
Core Claims Administration
For more than 20 years, Conduent’s HSP Core Claims Administration solution has helped payers improve operational efficiency and accelerate growth. Its modular architecture provides support for all lines of business while user-defined rules and configurable workflows help optimize the complete claims lifecycle.
With medical spend on the rise and regulations constantly changing, health plans need a partner to help educate and engage members throughout their healthcare journey while optimizing costs. Using proprietary analytics, comprehensive data and leading decision technology, we help payers build a 360-degree view of members, including socio-economic demographics, behaviors and medical risks.
Interoperability Conduent’s Interoperability solutions enable better care coordination for providers, seamless information exchange for payers and improved health outcomes for patients. Our solution is built on mandated industry standards leveraging HL7 FHIR® to implement key functions for security, interoperability of data exchange and data strategy.
Print and Fulfillment
Conduent has been providing print and fulfillment services for over 25 years. Our U.S.-based facilities produce more than 4.6 billion impressions representing over 850 million outbound mail pieces. We can support the production of a wide range of plan administration documents including:
1) ID Cards and EOBs
2) Premium billing and member correspondence
3) Provider checks and remittance
Customer Experience Management
Conduent brings decades of experience delivering customer service solutions that improve productivity, efficiency, and customer retention. Today, we have more than 140 domestic and offshore customer interaction centers, and offer support in more than 30 different languages. Conduent agents manage a wide range of customer service, sales and technical support for large-scale global programs.