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Streamlining Healthcare Payer Processes

There is a pressing need for Payers, Pharmacy Benefit Managers and Third Party Administrators to provide seamless digital member engagement across platforms and devices, support new product and service offerings, shift towards new market models like value-based payments and adhere to compliance requirements while holding down costs, and improving efficiency. Hexaware can be your partner and help you in your digital transformation journey to reduce costs, maximize efficiency and adapt to an ever changing regulatory landscape. We help you re-imagine member experience while re-engineering business processes leveraging a unique combination of intelligent automation and digital technologies. 

We are a Digital Transformation partner for a leading US based TPA and have been able to drive value through Digitization and Automation led IT transformation along with RPA enabled End-To-End BPS support (400+ claims processing specialists managing $1B+ policies with $5B+ payouts). There has been a 30% reduction in manual effort with 99.5% accuracy.

Service Offerings

  • Digital Engagement

    Hexaware’s digital member engagement solution helps Payers improve member experience in providing customizable out-of-the-box healthcare Payer CRM. Efficient engagement touchpoints are created by the usage of new-age channels like chatbots, Alexa, etc. Member sentiment and values are tracked across the member journey to develop strategies to enhance member satisfaction.

    The engagement layer is enabled by a microservice based API layer which encapsulates and presents the required services from the core legacy layer.

  • Automate Business Processes

    Hexaware’s Payer Digital Managed Services (DMS) help Payers to automate and optimize processes like enrollment, claims processing and billing thus improving efficiencies and overcoming functional deficiencies and gaps in legacy systems.

    With the help of Digital Operations Command Centre (unified interface to monitor and manage bots), Configuration Manager (configure business rule changes) and RoboBank, Payers can quickly launch a complete set of RPA and intelligent automation (AI/ ML) tools to improve STP and provide cost optimization with significantly higher accuracy.

  • Automate Testing

    Automation First approach helps automate all phases of testing from test case and synthetic data generation to test execution and reporting. Holistic automation for the entire testing life cycle across all layers of an application (UI, Service, Data layer) delivers the ability to adapt to market changes quickly. Automated testing of GUI of core administration platform, benefit plan changes and others help to reduce costs and effort with improved efficiency.

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