Healthcare Payer Services | Claims Management and Automation

Healthcare Payer Services

Hexaware brings in deep domain expertise in claims management services using processes that are compliant to global standards. Our processes leverage the use of home grown robotics that have been incorporated on large scale client engagement. By making use of our payer suite of services, you will be able to focus your energies on member engagement and other aspects that are critical to your business growth.

Our tailor made hFraud engine works collaboratively with social media, to stop revenue leakages that may result from inflated claims billing. Intelligent and robust reporting structure provides 360 degree view of your entire claims’ function.



  • Improve the accuracy of data during the pre-adjudication and adjudication process
  • Improve the process compliance by reducing the frauds
  • Enable continued enhancements by reducing claim overpayments, revenue leakages and turn around
  • Harness the deep domain expertise and best practices from the provider
  • Helps you focus on your core objectives and free up critical resources
  • Innovation through technology enablement can significantly reduce your total cost
  • Robotic automation helps you eradicate the costly, human-capital intensive processes that have long been associated with claims processing.
  • Claim analytics provides timely access to relevant data and consolidated view of information to help organizations to measure, monitor, and manage KPI’s across the claims life cycle.


Customer research and product creation Sales and marketing Policy acquisition Policy servicing Billing and collections Claims Processing Insurance accounts and regulatory reporting
  • Customer segmentation
  • Product design
  • Actuarial services
  • Regulatory approval
  • Background research and analytics
  • Distribution channel management
  • Direct sales
  • Outbound/inbound
  • Telesales
  • Marketing and advertising
  • Obtain , validate
  • Risk details
  • Policy validations
  • Premium calculations
  • Policy authorizations
  • Prepare and issue policy
  • Customer query handling
  • New business data entry
  • Maturity processing
  • Servicing for loans , surrenders and lapsation
  • Inbound call center
  • Capture and index queries and complaints
  • Update database
  • Prepare and send response
  • Refunds
  • Exception handling
  • Record remittance
  • Collect premiums
  • Produce bill statements
  • Reconciliations of bulk premiums
  • Handle billing queries
  • Payment processing
  • Assessment litigation
  • Complex claims assessments
  • Recovery of overpayments
  • Index claims
  • Register claims
  • Claims validations
  • Settlement
  • Invoice
  • Processing claims invoices
  • Generate reports for regulatory agencies
  • Tax processing
  • Payment processing
  • Bank reconciliations
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