Healthcare payer

Healthcare payers face significant challenges, including rising costs, improving care efficiency, achieving quality outcomes, and ensuring affordability. Enhancing member experience and enabling value-based care have now become critical priorities. Addressing these complexities requires deep domain knowledge and business operations expertise to analyze clinical states, pathways, claims, plan coverage, and other factors to optimise care delivery with a focus on affordability for members. Gen AI complements these efforts by automating data analysis, uncovering patterns, and simplifying insights to enable more informed and timely decision-making. Our Gen AI tool for Health features a comprehensive framework, reference architecture, and templatised business use cases, accelerating Gen AI adoption. This tool enables incremental adoption across clinical, financial, and operational use cases, seamlessly integrating business services and human oversight to unlock efficient operations, measurable outcomes, and tangible value.

Surveys have shown persistent dissatisfaction of health insurance customers with contact centers due to long wait times, issue resolution difficulties, lack of personalisation, and poor communication. The pandemic increased virtual behavioral health services 45-fold, changing customer expectations and affecting costs. Our intelligent customer operations solution for Health delivers a seamless, connected member experience. It integrates humans and technology to foster meaningful frictionless relationships, promoting loyalty and increased wallet-share. This approach aligns with the growing demand for healthcare payer solutions that enhance customer satisfaction. Our innovative offerings in real-time medical management, healthcare affordability, fraud, and abuse analytics help healthcare organisations to move the needle from illness to wellness. The market is moving towards enterprise-wide orchestration of contact centers as experience hubs, organising enterprise customer journeys to drive personalised interaction. AI is transforming contact centers into value-creating functions, ensuring efficient links between consumers and businesses while advancing insurance digital transformation.

We address these issues with a unified communication platform, automation, AI, wearable integration, health apps, and telehealth services. Our solution incorporates advanced healthcare payer analytics solutions to ensure strong security and compliance while meeting personalised service expectations.

CFOs are expected to be increasingly open and responsive, leveraging enhanced analytics, timeliness, accuracy, and better experiences to drive cost savings, flexibility, and scalability. For insurance CFOs, payer consulting and transformative initiatives must focus on measurable benefits that drive long-term value and align with their organisations’ strategic goals.
Our Intelligent Finance and Accounting Operations offer utilizes transformative solutions by combining advanced technology with best-in-class operating models. These solutions align with the needs of healthcare payer technology, enabling health insurers to build efficient, adaptable, and scalable finance functions across premium collection, claims payment, financial reporting, and budgeting and forecasting.
Enhanced insights and business collaboration drive cost efficiencies, compliance, and transparency for sustainable growth.
Our CFO-specific achievements include:

• 20-40% reduction in finance operating costs
• 20-30% reduction in aged debt on premiums and claims receivable
• 100% compliance with capital, reserve, and liquidity compliance
• Enhanced decision-making with detailed insights
• Time-to-close reduced to as little as three days
• Reduced early payments
• Increased satisfaction among customer, agent, broker, and employees
• A reduced carbon footprint and enhanced sustainability

By leveraging healthcare payer digital transformation and advanced automation, our solutions ensure finance operations will adapt and enable business growth.

With over 150+ use cases across Receivables, Payables, Controllership, and Financial Planning & Analysis, Gen AI can drive up to 95% of the automation rate, reducing time by 90%, reducing costs by 40% per case, increase satisfaction, and expand the role of finance and accounting as a strategic business partner.

In the fast-paced health insurance landscape, HR Excellence for People Experience redefines how insurers attract, engage, and retain skilled professionals.

The HR Function must adapt to meet business needs and employees’ expectations, especially as remote work becomes increasingly prevalent. Employee experience has become critical when it comes to engagement and retention, aligning closely with health insurance digital transformation efforts.
Our approach integrates advanced HR technologies and data-driven insights to enhance employee satisfaction and organizational performance. By streamlining HR processes, personalizing experiences, and aligning culture with insurer goals, we help build resilient, high-performing teams. These initiatives are tailored to meet the unique challenges of the healthcare payer industry, improving both employee and organizational outcomes.
Our scalable models support growth, delivering:

• Up to 90% increase in employee satisfaction
• Up to 30% cost reduction in HR operations over three years
• Up to 40% increase in productivity across five years
• Up to 30% reduction in queries.