Coforge helps solve people, process and technology challenges for some of the world’s largest and most complex health plans. We improve member experience and satisfaction by significantly reducing inefficiencies, process times and administrative efforts with automated, AI-native payer solutions.
Our healthcare payer solutions include:
AI and Application Managed Services
The technology backbone of any healthcare payer is its core business applications. When your applications run well, they drive down cost, ensure compliance, and deliver positive health and financial outcomes. When they don’t, they drive up cost and stifle innovation.
By combining AI with our managed services expertise, we help streamline processes and enable intelligent decision-making and exceptional member experiences — all while reducing costs and increasing operational efficiency.
Our AI platforms, digital engineering and automation capabilities, and healthcare domain expertise help optimize your application landscape and responsibly infuse AI to drive business outcomes. Our AI-driven managed services for healthcare payers include:
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Application portfolio modernization and rationalization
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Responsible AI and cognitive/GenAI-enabled application engineering
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AI-assisted application portfolio management
Digital and Connected Experiences
Driving health outcomes and increasing health equity while lowering the cost of care requires changing how you connect with patients and clinicians. You need to leverage data, engage consumers and redefine traditional relationships and boundaries, while staying compliant with regulations and managing technical debt.
We leverage deep technical capabilities and healthcare industry knowledge to deliver digital experience services that help payers:
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Accelerate differentiation in the marketplace
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Drive speed to market by leveraging agile digital experience and quality engineering
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Quickly adapt to change by adopting modern architectures and interoperability standards
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Leverage the power of AI while protecting sensitive data and avoiding bias
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Scale professional services and customer support capabilities globally
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Optimize IT operations through rationalization, modernization, shared services and cloud migration
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Set-up Global Capability Centers
Population Health, Care and Utilization Management
Industry research demonstrates the importance of social determinants of health. As concerns grow about health equity and the cost of care, the need for improved population health increases.
Population health programs control costs and help people live longer, healthier lives, but require modernizing clinical programs like care management (CM) and utilization management (UM).
Advances in technology are creating new opportunities to infuse population health principles into every area of your business. We work with payers to drive this change by:
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Improving speed to market through agile digital experience and transforming CM/UM and population health programs
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Safely applying AI to reduce friction in utilization management and increase engagement in health maintenance programs
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Managing Big Data and creating insights to understand the population you serve
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Quickly adapting to change by adopting modern architectures and interoperability
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Scaling professional services and customer support capabilities globally
Payer Business Process Optimization
As business complexity increases and the pace of change accelerates, it is becoming more difficult for healthcare payers to control costs without diluting quality. We help optimize both how your work is done and the cost of labor, so the core operational savings can be invested in your strategic initiatives.
Coforge’s business process optimization services enable you to contain costs and free-up internal resources to focus on core competencies and strategic goals, without sacrificing compliance or quality. We have the scale and expertise to execute business processes while simultaneously improving them.
Our payer BPO services are designed to:
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Deliver value-added customer service with skilled resources in lower cost locales
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Operate and automate back-office processes such as enrollment and billing
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Resolve manual claims interventions, ensuring SLAs with 24/7 production
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Improve efficiency and quality by designing, implementing, and delivering process optimization solutions
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Set up Global Capability Centers to build, operate, transfer and scale
