Legacy systems, regulations, manual processes and data security all make it difficult for small to mid-sized health plans to compete. Our comprehensive suite of solutions empower health plans to manage daily operations at scale. With advanced technology, time-tested processes and a global team of experts, health plans will be equipped to expand business and concentrate on what matters most – their members.
Deliver fast, accurate provider payments that help build strong provider relationships.
Drive engagement
Enroll and engage with members across their healthcare journey for healthier outcomes.
Maximize efficiency
Boost claims automation and accuracy with streamlined workflows and user-friendly interfaces.
One partner for a range of needs
Every day, we help industry-leading health plans reduce costs, enhance security and create better outcomes for their members, employees and communities – serving as a trusted advisor across your entire healthcare value chain.
End-to-end solutions for better healthcare outcomes
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.
Health Plan Administration: Commonly asked questions
How do claims processing systems create greater efficiencies? Processing claims can be a complicated and, in many cases, a manual process. Our system speeds up the process of adjudicating claims with embedded automation tools and user-defined workflows that can transform the process.
What are appeals and grievances? Appeals and grievances are a way for members to express dissatisfaction with services or care. Our appeals and Grievances can help resolve backlogs of unexpected appeals in under one month.
What factors should plans consider about enrollment? How can health plans make open enrollment season less burdensome? Open enrollment season can create resource challenges for healthcare plans. The increase of individual enrollment applications and shortened enrollment periods are causing membership departments to struggle to provide prompt, accurate reviews for the large volume of applications received. Our teams are able to decrease annual enrollment costs by millions while improving decision consistency, speed and accuracy with our enrollment automation solution.
How can payment integrity reduce the cost of health care? 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.
How can care coordination improve the member experience for health plans? Sorting through the multiple providers, services and claims found in a health plan can be confusing and time-consuming for members. Our experienced member advocates provide unbiased support to help remove barriers with a human-centric approach that creates meaningful connections and lasting member relationships.
How can health plans streamline their member and provider communication and fulfillment? 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. Conduent can help reduce administrative and production costs while better supporting member digital communication demands.
How can member contact centers improve member loyalty? 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.
