Genpact provides multi-shore Healthcare Payer solutions with a team of talented experts that includes nurses, certified clinical coders, physicians, statisticians and healthcare analysts experienced in over 30 healthcare information systems. They work side by side with your staff to help you reengineer and manage key processes, from claims management to finance and accounting.
Our services include:
Membership Management: Smarter processes create loyal customers
Genpact manages all aspects of member care, including enrollment, eligibility, premiums and policy maintenance. Multiple delivery centers save you money by operating close to your customers and responding to them via multiple channels in their own language. We proactively reduce the number of calls by analyzing customer behavior and focusing on predicting and resolving the customer’s issue on the first call. This in turn increases customer satisfaction and enhances long-term retention and loyalty.
Claims Management: Driving down fraud and abuse, driving up efficiency
Inefficiency and fraud cost payers billions every year…. Genpact’s solution sharply reduces both. Using our proven SEPSM framework, we focus on eliminating the inefficiencies that lead to errors in claims processing. By applying tighter controls, “smarter” processes, and 12 years of experience with handling 3.5 million claims activities per year, we ensure that documentation is complete, accurate and handled in the most cost-effective manner. Our Special Investigation Unit (SIU) saves payers millions each year by identifying aberrant billing behaviors; pursuing suspicious activities by both members and providers; and managing claims throughout their life cycle to effectively route out the potential for fraud, abuse and overpayments as well as erroneously paid claims.
Clinical Services: Ensuring your data is accurate, secure, and compliant
Payers need to protect sensitive data and ensure member security while meeting stringent standards for accuracy and privacy. Genpact drives accuracy and provides secure, effective access to data through a robust governance framework. Our Clinical Services include quality assurance and testing protocols and ICD-10 training initiatives as well as medical chart reviews to ensure accurate documentation. We also provide consolidation of medical records and data for underwriter review. Our goal is to save you time and money as well as to accurately identify missed and at-risk revenue to boost your bottom line
Provider Management: Optimizing your productivity
Your time is valuable. We help you make more of it with provider management services that take the burden of day-to-day activities off your staff and drive down costs. Genpact Provider Management includes database management, provider credentialing, and contracting services including pricing, maintenance and configuration. We provide the analytical insights payers need to negotiate fair and accurate rates with providers, ensuring superior care at fair prices.