Reimagine your health plan operations
Improve agility and enhance accuracy while lowering costs with process outsourcing
End-to-end process solutions for
health plans
Many healthcare plans today are challenged with delivering essential services due to staffing constraints, limitations of technology and the need to reduce administrative costs. Conduent offers a comprehensive suite of services to help healthcare plans manage daily operations at scale. Solutions such as automation and data digitization, combined with a global team of experts, can enable plans of any size to adapt to a wide variety of needs as you expand into new markets.
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Enhance accuracy
Automate administrative processes and eliminate errors with the power of AI and machine learning
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Improve agility
Reduce IT investments while adapting to client and government regulations with scalable support
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Lower costs
Improve productivity and reduce administrative expenses with the latest automation tools and a global workforce
Claims Processing
Saving over $5.4M in annual claims processing costs
Ramping up onshore staff can take up extra time that can jeopardize the provider relationships needed for healthcare plans to succeed in new markets. Since 2008, Conduent has provided outsourced claims processing services with 24/7 cross-trained resources to this large regional plan, adding speed and accuracy to grow to over 3.3M claims processed annually.
Appeals and Grievances
Helping a 20+ year customer overcome an appeals and grievances backlog
Seasonality and regional access limitations can create staffing challenges for healthcare plans that can negatively impact daily processes and member experiences. Learn how this national healthcare payer was able to save their Medicare Advantage STARS rating and Gold Star URAC accreditation after Conduent was able to resolve a backlog of unexpected appeals in under one month.
Enrollment
Driving down enrollment costs, delays and errors for a large West Coast health plan
The increase of individual enrollment plans and shortened enrollment periods are causing membership departments to struggle to provide prompt, accurate reviews for the large volume of applications received. Our teams were able to decrease annual enrollment costs by over $1M while improving decision consistency, speed and accuracy with our enrollment automation solution.
Digital Mailroom
Supercharging enrollment processing with intelligent automation for a Fortune 100 company
Late summer and early fall are the busiest times of the year for healthcare payers as they wrestle with large volumes of applications submitted. For Medicare enrollment, many forms are still handwritten and sent via mail or fax. Learn how solutions such as digital mailroom services can save time, reduce costs, and remove processing errors through automation.
Payment Integrity
Get more from your payment recovery efforts
Up to three percent of U.S. medical claims are paid incorrectly by healthcare payers. For some health plans, that could mean millions in potential savings with the right payment integrity strategy. Our healthcare payment accuracy solutions can seamlessly integrate with multiple data sources and technologies to quickly recover the most funds possible.
Care Coordination
Closing gaps in care
Sorting through the multiple providers, services and claims found in a health plan can be confusing and time-consuming for members. Learn how our experienced member advocates provide unbiased support to help remove barriers with a human-centric approach that creates meaningful connections and lasting member relationships.
Print and Digital Communications
Modernizing your transactional communications
Managing the high volume of timely, frequent and often compliance-dependent communications mandated in healthcare can challenge in-house resources. Further, as consumer demands for digital communications grow, many in-house facilities have to support the transformation from print to digital as well. Learn how one health plan outsourced operations to Conduent, reducing administrative and production costs while better supporting member digital communication demands.
Contact Center Operations
Enabling meaningful member connections
To deliver exceptional member interactions, experiences and results, health plans need an end-to-end CX ecosystem that can be integrated quickly and scale up or down based on fluctuating needs. Our cloud-based Customer Experience as a Service (CXaaS) Solution delivers the ultimate in flexibility, scalability and connectivity — seamlessly bringing together the people, process and platform today’s health plans need to create intelligent, omnichannel experiences that drive better outcomes for your members and your business.
Solutions for healthcare plans
As a leader in healthcare payer operations, our people, processes and technology help actively engage members, meet compliance requirements, optimize cost of care and improve overall operational performance.