Streamline application processing, speed new member acceptance and enhance underwriting consistency while reducing costs
As the number of individual plans such as Medicare Advantage and ACA plans continues to increase, so does the interest in outsourcing enrollment activities along with them. With more than 50 years of member enrollment experience, supported by a global workforce, Conduent offers customized services that can enhance your health plan capabilities. From application intake, to underwriting, to enrollment maintenance, we are your partners in driving exceptional outcomes for both your members and your organization.
Multi-Channel Enrollment Options
With the shift toward individual plans, health plans need to offer multiple, consumer friendly approaches to collecting new member enrollments. We provide a variety of enrollment intake options, from accepting and digitizing paper applications to creating mobile apps and enrollment portals that make it fast and easy for members to select the right plan.
Application Underwriting Automation
Validating application information and required supporting documentation can be a slow, inefficient process. Plus, a growing list of health plan specific, employer and CMS Special Enrollment Period (SEP) criteria create challenges for manual reviews, often resulting in inconsistencies and the potential for the acceptance of avoidable risks.
Our underwriting automation solution streamlines enrollment decisions. Working with our clients we establish custom enrollment acceptance criteria, which we then code into our enrollment review system. Application data received is reviewed against established criteria and automated reviews of supporting documentation are initiated and compared against plan data or external third-party data sources. In seconds, we can validate key enrollment data and capture supporting documentation to aid in future application audits or queries.
Enrollment Exception Queue Management
Automated enrollment and underwriting processes should result in upwards of 75% of applications being approved or denied without manual review. Unfortunately, applications that require review are often more complex and need special expertise to validate enrollment details against the criteria for the plan, employer, state and CMS. Our global team of enrollment experts can support client enrollment exception queues to quickly resolve pended applications based on client-specific rules and requirements.